Provider Demographics
NPI:1396862140
Name:MATZ, TODD MIKEL (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MIKEL
Last Name:MATZ
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 CYPRESSWOOD DR APT V13
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8345
Mailing Address - Country:US
Mailing Address - Phone:281-825-6724
Mailing Address - Fax:
Practice Address - Street 1:16713 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4213
Practice Address - Country:US
Practice Address - Phone:281-586-1364
Practice Address - Fax:281-586-1373
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22OtherATHLETIC TRAINER