Provider Demographics
NPI:1467642702
Name:FREY, MATTHEW AARON (RPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:FREY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 MARCASEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4616
Mailing Address - Country:US
Mailing Address - Phone:310-397-2372
Mailing Address - Fax:310-915-2086
Practice Address - Street 1:3966 MARCASEL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4616
Practice Address - Country:US
Practice Address - Phone:310-397-2372
Practice Address - Fax:310-915-2086
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist