Provider Demographics
NPI:1114632452
Name:SAUTER, MATTHEW H (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:SAUTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2913
Mailing Address - Country:US
Mailing Address - Phone:631-422-1474
Mailing Address - Fax:
Practice Address - Street 1:4925 MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6201
Practice Address - Country:US
Practice Address - Phone:516-308-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer