Provider Demographics
NPI:1609822899
Name:MATTSON, PAUL A JR (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:MATTSON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:706-204-8548
Mailing Address - Fax:
Practice Address - Street 1:631 CAMPBELL HILL ST NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1390
Practice Address - Country:US
Practice Address - Phone:770-424-6787
Practice Address - Fax:770-426-7925
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist