Individual
MATTHEW LALIBERTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
123 W 18TH STREET, CELLAR, NEW YORK, NY 10011
(646) 678-5980
Mailing address
401 WASHINGTON BLVD APT 2907, JERSEY CITY, NJ 07310-2230
(401) 365-7006
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
010742-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010742-1
THE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT
NY
Enumeration date
09/23/2021
Last updated
09/23/2021
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