Provider Demographics
NPI:1457541765
Name:MATTHEWS, JASON W (MSPT, OCS, COMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MSPT, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867W 181ST ST APT 1-I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4461
Mailing Address - Country:US
Mailing Address - Phone:646-704-4560
Mailing Address - Fax:
Practice Address - Street 1:867W 181ST ST APT 1I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4461
Practice Address - Country:US
Practice Address - Phone:646-704-4560
Practice Address - Fax:212-223-0198
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022249-12251X0800X
MEPT33012251X0800X
FLPT232102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic