Provider Demographics
NPI:1598255960
Name:MATRX HEALTH & FITNESS, LLC
Entity Type:Organization
Organization Name:MATRX HEALTH & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATP
Authorized Official - Phone:586-232-3644
Mailing Address - Street 1:16009 LEONE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4063
Mailing Address - Country:US
Mailing Address - Phone:586-232-3644
Mailing Address - Fax:248-579-0197
Practice Address - Street 1:16009 LEONE DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-4063
Practice Address - Country:US
Practice Address - Phone:586-232-3644
Practice Address - Fax:248-579-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010156212251N0400X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty