Provider Demographics
NPI:1750406419
Name:MATWIJCZUK, TONIA MARTA (PT)
Entity type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:MARTA
Last Name:MATWIJCZUK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GLEN OAK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6423
Mailing Address - Country:US
Mailing Address - Phone:615-338-4391
Mailing Address - Fax:
Practice Address - Street 1:104 GLEN OAK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6423
Practice Address - Country:US
Practice Address - Phone:615-338-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT 7724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist