Provider Demographics
NPI:1033327507
Name:MATHEW, TOMS K (RPT)
Entity Type:Individual
Prefix:
First Name:TOMS
Middle Name:K
Last Name:MATHEW
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 MOMENTUM PL
Mailing Address - Street 2:LOCKBOX 231467
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5314
Mailing Address - Country:US
Mailing Address - Phone:800-827-3797
Mailing Address - Fax:248-553-2108
Practice Address - Street 1:28309 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1666
Practice Address - Country:US
Practice Address - Phone:248-208-6100
Practice Address - Fax:248-208-6119
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist