Provider Demographics
NPI:1922215870
Name:SMELAS, MATTHEW (PT,OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SMELAS
Suffix:
Gender:M
Credentials:PT,OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VIRGINIA TER
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 MAPLE AVE
Practice Address - Street 2:CREST PHYSICAL THERAPY
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2104
Practice Address - Country:US
Practice Address - Phone:732-741-1119
Practice Address - Fax:732-741-1119
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00699900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00770512OtherRAILROAD MCR
NJP00770517OtherRAILROAD MCR
NJ152245V2NMedicare PIN
NJP00770517OtherRAILROAD MCR