Provider Demographics
NPI:1861881914
Name:PIANTEDOSI, MATTHEW P (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:PIANTEDOSI
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5421
Mailing Address - Country:US
Mailing Address - Phone:617-943-4466
Mailing Address - Fax:
Practice Address - Street 1:231 FOREST STREET
Practice Address - Street 2:BABSON COLLEGE
Practice Address - City:BABSON PARK
Practice Address - State:MA
Practice Address - Zip Code:02457
Practice Address - Country:US
Practice Address - Phone:781-239-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer