Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 5151009984 | MI |
N | 2081S0010X | Sports Medicine | 17692 | FL |
N | 213ES0000X | Sports Medicine | 17692 | FL |
Y | 2081S0010X | Sports Medicine | OS17692 | FL |
Y | 213ES0000X | Sports Medicine | OS17692 | FL |
NPI | 1265963193 |
---|---|
Provider Name | Laura Marie Mattson |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 13/07/2021 |