Provider Demographics
NPI:1720759947
Name:MATTERA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MATTERA PHYSICAL THERAPY LLC
Other - Org Name:MATTERA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:ANTONETTE
Authorized Official - Last Name:MATTERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:781-521-3336
Mailing Address - Street 1:43 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2318
Mailing Address - Country:US
Mailing Address - Phone:781-521-3336
Mailing Address - Fax:
Practice Address - Street 1:334 NEWBURY ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-0211
Practice Address - Country:US
Practice Address - Phone:781-521-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy