Provider Demographics
NPI:1760929111
Name:MATIE, ROBERT (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MATIE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:PA
Mailing Address - Zip Code:16313-4247
Mailing Address - Country:US
Mailing Address - Phone:814-726-2290
Mailing Address - Fax:
Practice Address - Street 1:100 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1868
Practice Address - Country:US
Practice Address - Phone:814-368-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant