Provider Demographics
NPI:1508285081
Name:MATOS, TERESA
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MATTHEWS MINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4029
Mailing Address - Country:US
Mailing Address - Phone:336-328-4890
Mailing Address - Fax:704-847-0758
Practice Address - Street 1:2625 CELESTE RD
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051
Practice Address - Country:US
Practice Address - Phone:336-508-2675
Practice Address - Fax:828-635-8351
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL053-0253747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant