Provider Demographics
NPI:1558543413
Name:MATUSZEWSKI, FABIOLA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:FABIOLA
Middle Name:
Last Name:MATUSZEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 E MONTEROSA ST # 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4857
Mailing Address - Country:US
Mailing Address - Phone:602-903-9353
Mailing Address - Fax:
Practice Address - Street 1:2222 E HIGHLAND AVE STE 310
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4879
Practice Address - Country:US
Practice Address - Phone:602-955-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7923A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant