Provider Demographics
NPI:1407919517
Name:MATTEI, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MATTEI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23085 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-4734
Mailing Address - Country:US
Mailing Address - Phone:301-475-2060
Mailing Address - Fax:
Practice Address - Street 1:40900 MERCHANTS LN
Practice Address - Street 2:SUITE 202
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3795
Practice Address - Country:US
Practice Address - Phone:301-997-1155
Practice Address - Fax:301-997-1199
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist