Provider Demographics
NPI:1659886018
Name:MATTRAS, PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MATTRAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7698 CAMERON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5659
Mailing Address - Country:US
Mailing Address - Phone:239-292-0478
Mailing Address - Fax:
Practice Address - Street 1:7698 CAMERON CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-5659
Practice Address - Country:US
Practice Address - Phone:239-292-0478
Practice Address - Fax:239-292-0478
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer