Provider Demographics
NPI:1639217169
Name:MATHEW, THOMAS (LPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-646-1935
Mailing Address - Fax:281-646-0927
Practice Address - Street 1:465 WEST PARKER ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091
Practice Address - Country:US
Practice Address - Phone:713-697-6722
Practice Address - Fax:713-694-3292
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650546OtherBCBS ID
TX1081537OtherPHYSICAL THERAPY LICENSE
TX650546OtherBCBS ID