Provider Demographics
NPI:1194853002
Name:MATKOWSKI, JARED F (LATC)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:F
Last Name:MATKOWSKI
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MCKEE ST APT K
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4859
Mailing Address - Country:US
Mailing Address - Phone:860-432-3581
Mailing Address - Fax:
Practice Address - Street 1:2928 MAIN ST
Practice Address - Street 2:EASTERN REHABILITATION NETWORK
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1007
Practice Address - Country:US
Practice Address - Phone:860-657-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer