Provider Demographics
NPI:1851589618
Name:MATSON PERFORMANCE GROUP
Entity Type:Organization
Organization Name:MATSON PERFORMANCE GROUP
Other - Org Name:MID-ATLANTIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-358-5500
Mailing Address - Street 1:1451 CONCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2104
Mailing Address - Country:US
Mailing Address - Phone:610-358-5500
Mailing Address - Fax:610-358-5579
Practice Address - Street 1:1451 CONCHESTER HWY
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19061-2104
Practice Address - Country:US
Practice Address - Phone:610-358-5500
Practice Address - Fax:610-358-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy