Provider Demographics
NPI:1447249826
Name:YAMPOLSKY, MATTHEW B (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:YAMPOLSKY
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17125 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4537
Mailing Address - Country:US
Mailing Address - Phone:954-540-8130
Mailing Address - Fax:
Practice Address - Street 1:8019 JOHN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5498
Practice Address - Country:US
Practice Address - Phone:954-540-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 9102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer