Provider Demographics
NPI:1114039120
Name:MATHEW, TINA M (DPT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:CHERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:370 E MAPLE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2859
Mailing Address - Country:US
Mailing Address - Phone:215-752-4553
Mailing Address - Fax:215-752-0703
Practice Address - Street 1:370 E MAPLE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2859
Practice Address - Country:US
Practice Address - Phone:215-752-4553
Practice Address - Fax:215-752-0703
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
104408JUWOtherMEDICARE PTAN