Provider Demographics
NPI:1831470871
Name:MATTER, GEHAN KADRI (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GEHAN
Middle Name:KADRI
Last Name:MATTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CARDAMON DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5059
Mailing Address - Country:US
Mailing Address - Phone:727-372-7609
Mailing Address - Fax:727-372-7609
Practice Address - Street 1:10901 CORPORATE CIR N
Practice Address - Street 2:STE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3722
Practice Address - Country:US
Practice Address - Phone:727-328-8308
Practice Address - Fax:727-328-8338
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant