Individual
MS. DESIREE ANN MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1710 NE FAIRVIEW AVE, GRANTS PASS, OR 97526-3877
(541) 479-2606
Mailing address
406 NE SILVERWOOD PL, GRANTS PASS, OR 97526-2226
(541) 450-2496
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06567
OR
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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