Provider Demographics
NPI:1457567984
Name:MATTIO, SUSAN (MPT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MATTIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4426
Mailing Address - Country:US
Mailing Address - Phone:609-841-6490
Mailing Address - Fax:
Practice Address - Street 1:1390 CAMP HILL RD
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19043
Practice Address - Country:US
Practice Address - Phone:215-643-0600
Practice Address - Fax:215-641-0628
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN573544163WX0200X
PAPT011812L225100000X
NJ40QA00788400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0200XNursing Service ProvidersRegistered NurseOncology
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist