Provider Demographics
NPI:1164634663
Name:MATZINGER, MILENA (PT)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:MATZINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MILENA
Other - Middle Name:
Other - Last Name:JARC-MATZINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:151 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6062
Mailing Address - Country:US
Mailing Address - Phone:408-736-6956
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist