Provider Demographics
NPI:1871558205
Name:HAVRANEK, MATTHEW (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:HAVRANEK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 S LOOMIS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3742
Mailing Address - Country:US
Mailing Address - Phone:914-475-6153
Mailing Address - Fax:
Practice Address - Street 1:1306 S LOOMIS
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3742
Practice Address - Country:US
Practice Address - Phone:914-475-6153
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer