Provider Demographics
NPI:1023368289
Name:MATA, JOSEPH CLARET REMIGIO (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH CLARET
Middle Name:REMIGIO
Last Name:MATA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WILSON LOOP
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-3966
Mailing Address - Country:US
Mailing Address - Phone:606-257-5325
Mailing Address - Fax:606-237-1461
Practice Address - Street 1:26901 US 119S
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514
Practice Address - Country:US
Practice Address - Phone:606-237-1460
Practice Address - Fax:606-237-1461
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist