Active NPI
Maggie Matassa
- Physical Therapist
- Middle River, MD
National Provider Identifier
1679337794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 29818
- Practice address
- 425 Williams CT Ste 116
Middle River, MD 21220-2898 - Phone
- (443) 963-3234
- NPI assigned
- Feb 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | JJ-0014823 | DE | |
| Physical Therapist | 225100000X | 051835-01 | NY | |
| Physical Therapist | 225100000X | 29818 | MD | Primary |
Addresses
Primary practice location
425 Williams CT Ste 116
Middle River, MD 21220-2898
Mailing address
124 Peterhoff Ave
Malverne, NY 11565-1398
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 |
|---|---|---|---|
| JJ-0014823 | DE | MD | Physical Therapist |
| 29818 | MD | MD | Physical Therapist |
| 051835-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1679337794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 PETERHOFF AVE",
"city": "MALVERNE",
"state": "NY",
"postal_code": "115651398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 WILLIAMS CT STE 116",
"city": "MIDDLE RIVER",
"state": "MD",
"postal_code": "212202898",
"telephone_number": "443-963-3234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATASSA",
"first_name": "MAGGIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-08",
"last_updated": "2024-02-08",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DE",
"license": "JJ-0014823",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "051835-01",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "29818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middle River, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.