Provider Demographics
NPI:1174765341
Name:MATNEY, JESSIE GENEVA (LPTA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:GENEVA
Last Name:MATNEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103H PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614
Mailing Address - Country:US
Mailing Address - Phone:276-935-5525
Mailing Address - Fax:
Practice Address - Street 1:1103 PLAZA DR STE H
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6625
Practice Address - Country:US
Practice Address - Phone:276-935-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist