Provider Demographics
NPI:1710565684
Name:MATSON THERAPY, LLC
Entity Type:Organization
Organization Name:MATSON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CMPT
Authorized Official - Phone:605-642-7996
Mailing Address - Street 1:520 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2320
Mailing Address - Country:US
Mailing Address - Phone:605-642-7996
Mailing Address - Fax:605-642-5955
Practice Address - Street 1:520 N CANYON ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2320
Practice Address - Country:US
Practice Address - Phone:605-642-7996
Practice Address - Fax:605-642-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty