Mark R Mateja, DPT/PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT4639 Issued in ME

Practice address

1 Jarrett White Rd
Tripler AMC, HI 96859-5001

Phone

(808) 433-6661

Fax

(808) 433-1551

NPI assigned

Aug 14, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thi of Nevada at Desert Valley Therapy, LLC

  dba Desert Valley Therapy

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1871547083
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1346432309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER AMC",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-6661",
            "fax_number": "808-433-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER AMC",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-6661",
            "fax_number": "808-433-1551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "BLDG 683 WAIANAE AVE",
            "address_purpose": "LOCATION",
            "city": "Schofield Barracks",
            "state": "HI",
            "postal_code": "96786",
            "country_code": "US",
            "telephone_number": "808-433-8500",
            "fax_number": "808-433-8505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATEJA",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "DPT/PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "2154",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346432309",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Edward Mallon, MD
• Thomas Gerard Marino, DMD
• John Warren Markham, CCP
• Pauline Aiko Mashima, M.S., CCC-SLP
• Lincoln Masuda
• Caylin Stephanie Mathews, FNP-C
• Levin A Matsukawa, LCSW, CSAC
• Mark Matsushita
• Justin Matsuura, PH.D.
• Melissa Ghormley Mattes, CCP

• Physical Therapist in Tripler AMC, HI
• Providers in Tripler AMC, HI by specialty
• Physical Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.