John David Matzoll, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1204 Issued in MN

Practice address

1350 Gardena Ave NE
Fridley, MN 55432-5830

Phone

(763) 571-9116

Fax

(763) 571-9118

NPI assigned

Mar 12, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609908870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 GARDENA AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325830",
            "telephone_number": "763-571-9116",
            "fax_number": "763-571-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 GARDENA AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325830",
            "telephone_number": "763-571-9116",
            "fax_number": "763-571-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATZOLL",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Troy Philip Mathias
• Kylie Renee Anne Mathieu, LADC
• Betty Nyaboke Matieso, RN
• Dorothy Mattson
• Lisa R Mattson, M.D.
• Marc Maus, LICSW
• Amy Kirsten Maynard, RN, MS, CCCRN, CCNS
• Krysta Victoria Mazur, LICSW
• Dienabou Mboup
• Melissa Otilia McCarty, PSYD, LP

• Athletic Trainer in Fridley, MN
• Providers in Fridley, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.