1578717898 NPI number — DR. MATHEW THOMAS PT, DPT, ATC/L, CEAS

Table of content: DR. MATHEW THOMAS PT, DPT, ATC/L, CEAS (NPI 1578717898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578717898 NPI number — DR. MATHEW THOMAS PT, DPT, ATC/L, CEAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
MATHEW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, ATC/L, CEAS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578717898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 S GILBERT RD
Provider Second Line Business Mailing Address:
SUITE 1-138
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249-5982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-895-0965
Provider Business Mailing Address Fax Number:
877-231-1174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5970 S COOPER RD
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85249-5393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-895-0965
Provider Business Practice Location Address Fax Number:
877-231-1174
Provider Enumeration Date:
11/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8030 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083928766 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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