Provider Demographics
NPI:1518430339
Name:MARY MATTIS P T INC
Entity type:Organization
Organization Name:MARY MATTIS P T INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-846-7062
Mailing Address - Street 1:465 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6541
Mailing Address - Country:US
Mailing Address - Phone:386-846-7062
Mailing Address - Fax:386-917-1915
Practice Address - Street 1:465 GREENWICH DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6541
Practice Address - Country:US
Practice Address - Phone:386-846-7062
Practice Address - Fax:386-917-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy