Provider Demographics
NPI:1043473879
Name:THOMAS, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0069
Mailing Address - Country:US
Mailing Address - Phone:702-346-3105
Mailing Address - Fax:702-346-3544
Practice Address - Street 1:210 N SANDHILL BLVD
Practice Address - Street 2:STE B
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4789
Practice Address - Country:US
Practice Address - Phone:702-346-3105
Practice Address - Fax:702-346-3544
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist