Provider Demographics
NPI:1679519219
Name:MATRIX REHABILITATION-GEORGIA, INC.
Entity type:Organization
Organization Name:MATRIX REHABILITATION-GEORGIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:665 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3941
Mailing Address - Country:US
Mailing Address - Phone:724-465-3496
Mailing Address - Fax:724-465-3726
Practice Address - Street 1:355 PHILIP BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8733
Practice Address - Country:US
Practice Address - Phone:770-513-3233
Practice Address - Fax:770-513-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116816Medicare Oscar/Certification