Provider Demographics
NPI:1407178924
Name:ALPHA FITNESS CLUB LLC
Entity Type:Organization
Organization Name:ALPHA FITNESS CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:412-303-0866
Mailing Address - Street 1:95 ENTERPRISE DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037
Mailing Address - Country:US
Mailing Address - Phone:412-896-9661
Mailing Address - Fax:412-896-9807
Practice Address - Street 1:95 ENTERPRISE ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2070
Practice Address - Country:US
Practice Address - Phone:412-896-9661
Practice Address - Fax:412-896-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016509261QP2000X
PADAPT001268261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy