Provider Demographics
NPI:1831227727
Name:MATTAR, MARTHA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:MATTAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARTINE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1516
Mailing Address - Country:US
Mailing Address - Phone:508-324-9300
Mailing Address - Fax:508-324-9309
Practice Address - Street 1:275 MARTINE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1516
Practice Address - Country:US
Practice Address - Phone:508-324-9300
Practice Address - Fax:508-324-9309
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705217Medicaid
MAY69706Medicare ID - Type Unspecified