Provider Demographics
NPI:1417263773
Name:MATSON, EMILY M (PTA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:M
Last Name:MATSON
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3677
Mailing Address - Country:US
Mailing Address - Phone:414-649-3250
Mailing Address - Fax:414-649-3245
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-649-3250
Practice Address - Fax:414-649-3245
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1688-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant