Provider Demographics
NPI:1235194572
Name:MATASSA, THOMAS J (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:MATASSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PETERHOFF AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1398
Mailing Address - Country:US
Mailing Address - Phone:516-596-3310
Mailing Address - Fax:
Practice Address - Street 1:4427 DOUGLASTON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1843
Practice Address - Country:US
Practice Address - Phone:718-281-2861
Practice Address - Fax:718-281-0173
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ78781Medicare ID - Type UnspecifiedPHYSICAL THERAPIST