Provider Demographics
NPI:1336107945
Name:MATTIS, TIMOTHY FRANK (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:FRANK
Last Name:MATTIS
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 1:1231 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2051
Mailing Address - Country:US
Mailing Address - Phone:650-368-8819
Mailing Address - Fax:
Practice Address - Street 1:1100 INDUSTRIAL RD STE 11A
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4167
Practice Address - Country:US
Practice Address - Phone:650-593-9700
Practice Address - Fax:650-593-9701
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist