Provider Demographics
NPI:1760718423
Name:TORTORA, MATTHEW C (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:TORTORA
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 1:1 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2200
Mailing Address - Country:US
Mailing Address - Phone:978-531-5008
Mailing Address - Fax:
Practice Address - Street 1:1 ROOSEVELT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2200
Practice Address - Country:US
Practice Address - Phone:978-531-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist