Jacob Matthew Mattia, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501302104 Issued in MI

Practice address

395 N Groesbeck Hwy Ste L
Mount Clemens, MI 48043-1561

Phone

(586) 630-0474

Fax

(586) 630-0476

NPI assigned

May 27, 2022

Last updated

May 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Health Alliance LLCGroup PAC ID 2860776648, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Health Alliance LLC

  • Physical Therapist
  • Mount Clemens, MI
  • NPI 1467904615
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1447999529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54313 SCARBORO WAY",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483161287",
            "telephone_number": "248-321-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 N GROESBECK HWY STE L",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480431561",
            "telephone_number": "586-630-0474",
            "fax_number": "586-630-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIA",
        "first_name": "JACOB",
        "middle_name": "MATTHEW",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwight A Mason
• Mohammed T Masri, MD
• Elizabeth Masserang, LMSW
• Stanley Anthony Materka, DO
• Sebastian Matti
• Michael John Mattingly, DO
• Adam Matynowski, DO
• Brittany Nicole Maul
• Brittany Nicole Maxwell
• Hugh James Maxwell Jr.

• Physical Therapist in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.