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Individual
MR. LARRY WAYNE MATTOCKS JR.
Active
Individual
MR. LARRY WAYNE MATTOCKS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007303L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025221
MEDICARE GROUP
PA
05
—
1016368810002
—
PA
01
—
104392
UPMC
PA
01
—
118111
MEDICARE GROUP
PA
01
—
1983093
HIGHMARK GROUP
PA
01
—
220033
HEALTH AMERICA/HEALTH ASSURANCE
PA
01
—
417718
HIGHMARK
PA
01
—
5160144
AETNA
PA
01
—
548783
HIGHMARK GROUP
PA
01
—
579C
UPMC
PA
01
—
724159
HEALTH AMERICA/HEALTH ASSURANCE
PA
Enumeration date
01/18/2006
Last updated
05/19/2008
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