Provider Demographics
NPI:1841696242
Name:MATTHEWS, TRACY (PTA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT UNION
Mailing Address - State:PA
Mailing Address - Zip Code:17066-1275
Mailing Address - Country:US
Mailing Address - Phone:814-251-2700
Mailing Address - Fax:
Practice Address - Street 1:212 W WATER ST
Practice Address - Street 2:
Practice Address - City:MOUNT UNION
Practice Address - State:PA
Practice Address - Zip Code:17066-1275
Practice Address - Country:US
Practice Address - Phone:814-251-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002573225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant