Provider Demographics
NPI:1760964340
Name:MATTHEW ROOT DO INC
Entity Type:Organization
Organization Name:MATTHEW ROOT DO INC
Other - Org Name:INNOVATIVE PAIN AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-621-0019
Mailing Address - Street 1:13320 RIVERSIDE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2512
Mailing Address - Country:US
Mailing Address - Phone:818-621-0019
Mailing Address - Fax:818-671-5556
Practice Address - Street 1:13320 RIVERSIDE DR STE 214
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2512
Practice Address - Country:US
Practice Address - Phone:818-621-0019
Practice Address - Fax:818-671-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty