Provider Demographics
NPI:1417415951
Name:MATLON, KEVIN JAMES (PT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:MATLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WOOTTON STREET
Mailing Address - Street 2:UNITS I AND J
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1939
Mailing Address - Country:US
Mailing Address - Phone:973-794-6040
Mailing Address - Fax:973-794-6041
Practice Address - Street 1:315 WOOTTON STREET
Practice Address - Street 2:UNITS I AND J
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1939
Practice Address - Country:US
Practice Address - Phone:973-794-6040
Practice Address - Fax:973-794-6041
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01845900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist