Provider Demographics
NPI:1538709449
Name:MATTAINI, JACOPO (PT, DPT, MCSP)
Entity type:Individual
Prefix:
First Name:JACOPO
Middle Name:
Last Name:MATTAINI
Suffix:
Gender:M
Credentials:PT, DPT, MCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 39TH ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2550
Mailing Address - Country:US
Mailing Address - Phone:646-422-5900
Mailing Address - Fax:
Practice Address - Street 1:148 39TH ST FL 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2550
Practice Address - Country:US
Practice Address - Phone:646-422-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0387862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic