Provider Demographics
NPI:1730592809
Name:ZANIS, MATTHEW GEORGE (PT, DPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE
Last Name:ZANIS
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 E GOLD DUST AVE
Mailing Address - Street 2:APARTMENT 2045
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1400
Mailing Address - Country:US
Mailing Address - Phone:570-617-0626
Mailing Address - Fax:
Practice Address - Street 1:9745 W HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1241
Practice Address - Country:US
Practice Address - Phone:623-572-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14863261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy