Provider Demographics
NPI:1700456373
Name:MATZEN, JOHN D (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:MATZEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:ME
Mailing Address - Zip Code:04330-2103
Mailing Address - Country:US
Mailing Address - Phone:207-624-1092
Mailing Address - Fax:
Practice Address - Street 1:54 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:ME
Practice Address - Zip Code:04330-2103
Practice Address - Country:US
Practice Address - Phone:207-624-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist