Provider Demographics
NPI:1578161972
Name:MATRUSKI, MARK (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MATRUSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MERRIMON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1244
Mailing Address - Country:US
Mailing Address - Phone:828-785-4700
Mailing Address - Fax:828-552-5566
Practice Address - Street 1:59 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3951
Practice Address - Country:US
Practice Address - Phone:828-966-9036
Practice Address - Fax:828-966-4538
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist