Organization Name: | MATSON PERFORMANCE GROUP |
NPI Number: | 1851589618 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN MATSON (OWNER) |
Mailing Address: | 1451 Conchester Hwy Garnet Valley |
State: | PA US |
Postal Code: | 190612104 |
Phone Number: | 6103585500 |
Fax Number: | 6103585579 |
NPI Enumeration Date: | 10/05/2007 |
NPI Last Update Date: | 10/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |