Provider Demographics
NPI:1801176052
Name:MATTSON, MARILYN J (CMT, BFA)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:J
Last Name:MATTSON
Suffix:
Gender:F
Credentials:CMT, BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4647
Mailing Address - Country:US
Mailing Address - Phone:925-352-6547
Mailing Address - Fax:
Practice Address - Street 1:1924 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4647
Practice Address - Country:US
Practice Address - Phone:925-352-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1447172M00000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No174400000XOther Service ProvidersSpecialist