1518289578 NPI number — MATTIA REHAB & SPINAL CARE CENTER, P.A.

Table of content: (NPI 1518289578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518289578 NPI number — MATTIA REHAB & SPINAL CARE CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTIA REHAB & SPINAL CARE CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GERALD R. MATTIA D.C.,P.A.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518289578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8915 CONROY WINDERMERE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32835-3127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-909-4788
Provider Business Mailing Address Fax Number:
407-909-1788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8915 CONROY WINDERMERE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32835-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-909-4788
Provider Business Practice Location Address Fax Number:
407-909-1788
Provider Enumeration Date:
02/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MATTIA
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-909-4788

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH2832 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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