Provider Demographics
NPI:1346511706
Name:VOLA, MATT (LMT)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:VOLA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1036
Mailing Address - Country:US
Mailing Address - Phone:515-222-1577
Mailing Address - Fax:
Practice Address - Street 1:8421 UNIVERSITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-1036
Practice Address - Country:US
Practice Address - Phone:515-222-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist