Provider Demographics
NPI:1851552475
Name:MATONDANE, JOYCE K
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:K
Last Name:MATONDANE
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 1:504 PERRAULT DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8633
Mailing Address - Country:US
Mailing Address - Phone:269-753-2194
Mailing Address - Fax:919-467-2148
Practice Address - Street 1:504 PERRAULT DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8633
Practice Address - Country:US
Practice Address - Phone:269-753-2194
Practice Address - Fax:919-467-2148
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC069CNOtherBCBS
NCP00651353OtherMEDICARE RAILROAD
NCDO0034OtherMEDICARE RAILROAD
NCDO0034OtherMEDICARE RAILROAD