Provider Demographics
NPI:1518516442
Name:MATA, ANALYSA TERESA
Entity Type:Individual
Prefix:
First Name:ANALYSA
Middle Name:TERESA
Last Name:MATA
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 1:6720 29TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:270 ALLES DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CA
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-351-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer