Provider Demographics
NPI:1427191626
Name:MATTHIAS, SCOTT DENNIS (ATC, CSCS, MBA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DENNIS
Last Name:MATTHIAS
Suffix:
Gender:M
Credentials:ATC, CSCS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98719 IHO PLACE 5-1104
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-719 IHO PL # 5-1104
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-2515
Practice Address - Country:US
Practice Address - Phone:808-293-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer