Provider Demographics
NPI:1811488596
Name:MATYOK, GARY WILLIAM II
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:WILLIAM
Last Name:MATYOK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 FERNCREEK DR STE 801
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2572
Mailing Address - Country:US
Mailing Address - Phone:910-710-5051
Mailing Address - Fax:910-223-6233
Practice Address - Street 1:4140 FERNCREEK DR STE 801
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2572
Practice Address - Country:US
Practice Address - Phone:910-710-5051
Practice Address - Fax:910-223-6233
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist