Provider Demographics
NPI:1861759664
Name:MATOVU, MATTHEW WALTER (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WALTER
Last Name:MATOVU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 F ST NW STE 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2761
Mailing Address - Country:US
Mailing Address - Phone:202-912-8480
Mailing Address - Fax:202-912-8484
Practice Address - Street 1:2112 F ST NW STE 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2761
Practice Address - Country:US
Practice Address - Phone:202-912-8480
Practice Address - Fax:202-912-8484
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24899225100000X
DCPT210002152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist