Provider Demographics
NPI:1003122425
Name:MATHIEU, GAIL ANN (PTA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8511
Mailing Address - Country:US
Mailing Address - Phone:469-585-0465
Mailing Address - Fax:972-559-1867
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3720
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021325225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant