Provider Demographics
NPI:1437471539
Name:MATANICH, MATHEW (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:MATANICH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 W NORTHMARKET ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1221
Mailing Address - Country:US
Mailing Address - Phone:765-542-0431
Mailing Address - Fax:765-599-3127
Practice Address - Street 1:2200 FOREST RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-521-1131
Practice Address - Fax:765-599-3127
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000288A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer