Individual
JENS K MATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT. DPT, OCS, CMPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2085
SD
225100000X
Physical Therapist
60718
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R194790
MEDICARE
OR
Enumeration date
08/12/2014
Last updated
10/09/2020
Update your record
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