Provider Demographics
NPI:1659688844
Name:MATESI, ANN MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MATESI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GALES LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3839
Mailing Address - Country:US
Mailing Address - Phone:410-964-0008
Mailing Address - Fax:
Practice Address - Street 1:515 BRIGHTFIELD RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-3643
Practice Address - Country:US
Practice Address - Phone:410-296-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist