Provider Demographics
NPI:1679735294
Name:PIECHOSKI, MATTHEW CHARLES (ATC, CES)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:PIECHOSKI
Suffix:
Gender:M
Credentials:ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-2662
Mailing Address - Country:US
Mailing Address - Phone:254-644-0048
Mailing Address - Fax:
Practice Address - Street 1:1500 S UNIVERSITY PARKS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1731
Practice Address - Country:US
Practice Address - Phone:254-710-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer