Huston Johnson Mattson IV, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

LAT-2474 Issued in NC

Practice address

4901 Weddington Rd
Matthews, NC 28104-6267

Phone

(704) 296-6319

NPI assigned

Apr 18, 2014

Last updated

Sep 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1619397569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5206 CHELSEY LN",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281108618",
            "telephone_number": "412-979-9047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 WEDDINGTON RD",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281046267",
            "telephone_number": "704-296-6319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Westchester Dr",
            "address_purpose": "LOCATION",
            "city": "Wexford",
            "state": "PA",
            "postal_code": "150909698",
            "country_code": "US",
            "telephone_number": "412-979-9047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTSON",
        "first_name": "HUSTON",
        "middle_name": "JOHNSON",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT004679",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "LAT-2474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ernest Prince Matthews II, LMT
• Robert Charles Matulonis, D.O.
• Larry Maugel, M.D.
• Mavilcare Home Health Agency (Mavilcare Home Care Agency)
• Max Motion
• Rosalyn Gioia Mazoway, MS RN

• Athletic Trainer in Matthews, NC
• Providers in Matthews, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.