Provider Demographics
NPI:1184956856
Name:MATTIA, PAULETTE MARY (BS, DC)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:MARY
Last Name:MATTIA
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 CONROY WINDERMERE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3127
Mailing Address - Country:US
Mailing Address - Phone:407-909-4788
Mailing Address - Fax:407-909-1788
Practice Address - Street 1:8915 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3127
Practice Address - Country:US
Practice Address - Phone:407-909-4788
Practice Address - Fax:407-909-1788
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor