Provider Demographics
NPI:1811273329
Name:MATZ, NEIL GREGORY (ATC, PES)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:GREGORY
Last Name:MATZ
Suffix:
Gender:M
Credentials:ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4591 LARCH DR
Mailing Address - Street 2:C45
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5110
Mailing Address - Country:US
Mailing Address - Phone:570-401-2759
Mailing Address - Fax:
Practice Address - Street 1:4591 LARCH DR
Practice Address - Street 2:C45
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5110
Practice Address - Country:US
Practice Address - Phone:570-401-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0046072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer