Provider Demographics
NPI:1942888102
Name:MATOS, TATIANA (MT)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 JEFFERSON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3847
Mailing Address - Country:US
Mailing Address - Phone:401-423-4433
Mailing Address - Fax:401-204-1100
Practice Address - Street 1:222 JEFFERSON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3847
Practice Address - Country:US
Practice Address - Phone:401-423-4433
Practice Address - Fax:401-204-1100
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist