Provider Demographics
NPI:1659643914
Name:MATSEN, DREW WILLIAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:WILLIAM
Last Name:MATSEN
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 1:7 HOOF PRINT RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-6001
Mailing Address - Country:US
Mailing Address - Phone:914-474-3129
Mailing Address - Fax:
Practice Address - Street 1:7 HOOF PRINT RD
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-6001
Practice Address - Country:US
Practice Address - Phone:914-474-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031967225100000X
CT008731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist