Individual
TERRY KEVIN MATTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2230 N TRIPHAMMER RD, ITHACA, NY 14850-6513
(607) 266-5316
(607) 266-5353
Mailing address
136 PINE TREE RD, ITHACA, NY 14850-6332
(607) 272-9789
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0036971
NY
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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