Provider Demographics
NPI:1194363747
Name:MATSON, JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MATSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:IL
Mailing Address - Zip Code:61273-9633
Mailing Address - Country:US
Mailing Address - Phone:309-373-3986
Mailing Address - Fax:
Practice Address - Street 1:4450 48TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-9213
Practice Address - Country:US
Practice Address - Phone:309-558-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0948042081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine