Provider Demographics
NPI:1699341289
Name:MATIS, PEGGY ANNE (PT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANNE
Last Name:MATIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 EL DORADO DR APT 34I
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-3840
Mailing Address - Country:US
Mailing Address - Phone:714-381-5955
Mailing Address - Fax:562-296-8995
Practice Address - Street 1:13660 EL DORADO DR APT 34I
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-3840
Practice Address - Country:US
Practice Address - Phone:714-381-5955
Practice Address - Fax:562-296-8995
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56522251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics