Active NPI
Mandy Matteis, MPT
- Physical Therapist
- Tampa, FL
National Provider Identifier
1164762183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 19149
- Practice address
- 16001 Lakeshore Villa Dr
Tampa, FL 33613-1336 - Phone
- (321) 848-8730
- NPI assigned
- Feb 28, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 19149 | FL | Primary |
Addresses
Primary practice location
16001 Lakeshore Villa Dr
Tampa, FL 33613-1336
Mailing address
PO Box 192
Lithia, FL 33547-0192
Phone (321) 848-8730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19149 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362009600000",
"number": "1164762183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 192",
"city": "LITHIA",
"state": "FL",
"postal_code": "335470192",
"telephone_number": "321-848-8730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16001 LAKESHORE VILLA DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336131336",
"telephone_number": "321-848-8730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTEIS",
"first_name": "MANDY",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-28",
"last_updated": "2013-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "19149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.