Provider Demographics
NPI:1255469060
Name:DEMATTEIS, CYNTHIA CATHERINE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:CATHERINE
Last Name:DEMATTEIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31359 MORLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1637
Mailing Address - Country:US
Mailing Address - Phone:734-765-3714
Mailing Address - Fax:
Practice Address - Street 1:10020 PROFESSIONAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-6906
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer