Provider Demographics
NPI:1659481141
Name:MATHESON, ORLY (PA-C)
Entity Type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:MATHESON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21073 POWERLINE RD STE 35
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2306
Mailing Address - Country:US
Mailing Address - Phone:561-489-8955
Mailing Address - Fax:561-489-8960
Practice Address - Street 1:21073 POWERLINE RD STE 35
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2306
Practice Address - Country:US
Practice Address - Phone:561-489-8955
Practice Address - Fax:561-489-8960
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3732Medicare UPIN