Provider Demographics
NPI:1891834982
Name:MATOSO, DAVID MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MATOSO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 GATEWAY DR
Mailing Address - Street 2:STE 110
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-4001
Mailing Address - Country:US
Mailing Address - Phone:650-345-2739
Mailing Address - Fax:650-345-2756
Practice Address - Street 1:1810 GATEWAY DR
Practice Address - Street 2:STE 110
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-4001
Practice Address - Country:US
Practice Address - Phone:650-345-2739
Practice Address - Fax:650-345-2756
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142342251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01917ZMedicare ID - Type Unspecified