Provider Demographics
NPI:1164175451
Name:FROEHLICH, MATTHEW C (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:FROEHLICH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3015
Mailing Address - Country:US
Mailing Address - Phone:631-806-4588
Mailing Address - Fax:
Practice Address - Street 1:600 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6015
Practice Address - Country:US
Practice Address - Phone:631-271-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010387-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant