Individual
JENNIFER LYNN MATYAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225100000X
Physical Therapist
Primary
62820
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500744666
—
OR
Enumeration date
04/18/2008
Last updated
06/27/2018
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