Provider Demographics
NPI:1598776940
Name:MATAN, CHRIS TOPHER J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CHRIS TOPHER
Middle Name:J
Last Name:MATAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:J
Other - Last Name:MATAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:54 W AVON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3680
Mailing Address - Country:US
Mailing Address - Phone:860-675-0357
Mailing Address - Fax:860-675-0358
Practice Address - Street 1:54 W AVON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3680
Practice Address - Country:US
Practice Address - Phone:860-675-0357
Practice Address - Fax:860-675-0358
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11341722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic