Provider Demographics
NPI:1619172079
Name:MATZ, ALEXANDER M (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:M
Last Name:MATZ
Suffix:
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 1:1065 KANE CONCOURSE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2100
Mailing Address - Country:US
Mailing Address - Phone:305-866-5050
Mailing Address - Fax:305-866-5450
Practice Address - Street 1:1065 KANE CONCOURSE
Practice Address - Street 2:SUITE 101
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2100
Practice Address - Country:US
Practice Address - Phone:305-866-5050
Practice Address - Fax:305-866-5450
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3189ZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST