Provider Demographics
NPI:1093015745
Name:MATIAS, THYRA ISABEL (RPA-C)
Entity Type:Individual
Prefix:
First Name:THYRA
Middle Name:ISABEL
Last Name:MATIAS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:THYRA
Other - Middle Name:ISABEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:281 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3511
Mailing Address - Country:US
Mailing Address - Phone:508-226-2213
Mailing Address - Fax:508-431-2637
Practice Address - Street 1:281 COUNTY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3511
Practice Address - Country:US
Practice Address - Phone:508-226-2213
Practice Address - Fax:508-431-2637
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014402363AS0400X
MAPA5665363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA5665OtherMA LICENSE