Provider Demographics
NPI:1447524400
Name:MATTES, LAURA L (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MATTES
Suffix:
Gender:F
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 1:20 PATRIOT PL
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1375
Mailing Address - Country:US
Mailing Address - Phone:508-718-4664
Mailing Address - Fax:
Practice Address - Street 1:20 PATRIOT PL
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1375
Practice Address - Country:US
Practice Address - Phone:508-718-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist