Provider Demographics
NPI:1265297238
Name:PHILIP, MATTIGAN ANN
Entity type:Individual
Prefix:
First Name:MATTIGAN
Middle Name:ANN
Last Name:PHILIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 WATERWHEEL LN
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2300
Mailing Address - Country:US
Mailing Address - Phone:240-743-1575
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD STE 155
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2950
Practice Address - Country:US
Practice Address - Phone:443-444-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant