Provider Demographics
NPI:1619395993
Name:MATHEW, NISHA (PT)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-8089
Mailing Address - Country:US
Mailing Address - Phone:630-746-2437
Mailing Address - Fax:
Practice Address - Street 1:2121 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-8089
Practice Address - Country:US
Practice Address - Phone:630-746-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist