Provider Demographics
NPI:1760379648
Name:MATTICE, ZOE
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:MATTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-9709
Mailing Address - Country:US
Mailing Address - Phone:315-759-1899
Mailing Address - Fax:
Practice Address - Street 1:848 PEIRSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9762
Practice Address - Country:US
Practice Address - Phone:315-331-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP135089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist