Provider Demographics
NPI:1770869158
Name:PASCUZZI, MATTHEW SCOTT (PTA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:PASCUZZI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SHAWNEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-999-2030
Mailing Address - Fax:419-991-0909
Practice Address - Street 1:50 LANGMAID LN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3930
Practice Address - Country:US
Practice Address - Phone:814-362-6090
Practice Address - Fax:814-362-2841
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008948225200000X
PATEI003780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant