Provider Demographics
NPI:1508300831
Name:MATHEWS, REJU
Entity Type:Individual
Prefix:MR
First Name:REJU
Middle Name:
Last Name:MATHEWS
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 1:2000 E ARAPAHO RD
Mailing Address - Street 2:APT #22106
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3180
Mailing Address - Country:US
Mailing Address - Phone:469-371-2544
Mailing Address - Fax:
Practice Address - Street 1:1350 E LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4106
Practice Address - Country:US
Practice Address - Phone:972-220-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2113840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant