Provider Demographics
NPI:1396904298
Name:MATZEK, MARK THOMAS (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:MATZEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:THERAPY SERVICES 1963 SOUTH MEMORIAL PARKWAY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5035
Mailing Address - Country:US
Mailing Address - Phone:256-265-7101
Mailing Address - Fax:256-265-6655
Practice Address - Street 1:THERAPY SERVICES 1963 SOUTH MEMORIAL PARKWAY
Practice Address - Street 2:SUITE 12
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5035
Practice Address - Country:US
Practice Address - Phone:256-265-7101
Practice Address - Fax:256-265-6655
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1590174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist