Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT024398 | PA |
NPI | 1003299744 |
---|---|
Provider Name | Jamie Mattswell |
First Address | Corry, PA 16407-9014 |
Second Address | Corry, PA 16407-9014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1032477930003 | (05) | PA |