Provider Demographics
NPI:1487790689
Name:MATTFELD, RAYMOND FRANCIS (PT, ATC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:FRANCIS
Last Name:MATTFELD
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ORINOCO DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1307
Mailing Address - Country:US
Mailing Address - Phone:631-665-9056
Mailing Address - Fax:631-665-9058
Practice Address - Street 1:160 ORINOCO DR
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1307
Practice Address - Country:US
Practice Address - Phone:631-665-9056
Practice Address - Fax:631-665-9058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012480-12251X0800X
NY000707-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ70151Medicare PIN