Provider Demographics
NPI:1417594433
Name:MATHEWS, CIBU (PT, MS , CERT MDT)
Entity Type:Individual
Prefix:
First Name:CIBU
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:PT, MS , CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HIGHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2865
Mailing Address - Country:US
Mailing Address - Phone:734-716-7205
Mailing Address - Fax:
Practice Address - Street 1:6 EXECUTIVE PLZ STE 280
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6833
Practice Address - Country:US
Practice Address - Phone:914-597-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist