Provider Demographics
NPI:1578717898
Name:THOMAS, MATHEW (PT, DPT, ATC/L, CEAS)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT, DPT, ATC/L, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 S GILBERT RD
Mailing Address - Street 2:SUITE 1-138
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5982
Mailing Address - Country:US
Mailing Address - Phone:480-895-0965
Mailing Address - Fax:877-231-1174
Practice Address - Street 1:5970 S COOPER RD
Practice Address - Street 2:#4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5393
Practice Address - Country:US
Practice Address - Phone:480-895-0965
Practice Address - Fax:877-231-1174
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1083928766OtherGROUP NPI