Provider Demographics
NPI:1780984880
Name:MATTER, SALLY WAFFIK (PT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:WAFFIK
Last Name:MATTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SALY
Other - Middle Name:WAFIK
Other - Last Name:BOGHDADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:342 S PUENTE ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5259
Mailing Address - Country:US
Mailing Address - Phone:626-722-7249
Mailing Address - Fax:
Practice Address - Street 1:1347 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5046
Practice Address - Country:US
Practice Address - Phone:626-857-4711
Practice Address - Fax:626-857-4712
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT36480OtherPHYSICAL THERAPY BOARD OF CALIFORNIA