Provider Demographics
NPI:1649991191
Name:MATJEKA, SCOTT A (PT, DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:MATJEKA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 BULVERDE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4572
Mailing Address - Country:US
Mailing Address - Phone:830-980-6880
Mailing Address - Fax:
Practice Address - Street 1:2395 BULVERDE RD STE 101
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4572
Practice Address - Country:US
Practice Address - Phone:830-980-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist