Provider Demographics
NPI:1144259474
Name:MATIAS, FELIX ANTONIO (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:FELIX
Middle Name:ANTONIO
Last Name:MATIAS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 IDLE FOREST PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5767
Mailing Address - Country:US
Mailing Address - Phone:813-875-3159
Mailing Address - Fax:
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:PCD 1017
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-9951
Practice Address - Country:US
Practice Address - Phone:813-974-8171
Practice Address - Fax:813-974-0822
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885290100Medicaid
FLEO616ZMedicare PIN