Provider Demographics
NPI:1518289578
Name:MATTIA REHAB & SPINAL CARE CENTER, P.A.
Entity Type:Organization
Organization Name:MATTIA REHAB & SPINAL CARE CENTER, P.A.
Other - Org Name:GERALD R. MATTIA D.C.,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:407-909-4788
Mailing Address - Street 1:8915 CONROY WINDERMERE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3127
Mailing Address - Country:US
Mailing Address - Phone:407-909-4788
Mailing Address - Fax:407-909-1788
Practice Address - Street 1:8915 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3127
Practice Address - Country:US
Practice Address - Phone:407-909-4788
Practice Address - Fax:407-909-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty