Individual
MATTHEW T BASA IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
101 POTTERS LN, CLARKSVILLE, IN 47129-1017
(812) 948-0808
Mailing address
101 POTTERS LN, CLARKSVILLE, IN 47129-1017
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05008415A
IN
225100000X
Physical Therapist
Primary
PT-004721
KY
Other
Enumeration date
06/29/2007
Last updated
07/10/2008
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