Provider Demographics
NPI:1679549364
Name:MATHEWS, TIMOTHY DOUGLAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DOUGLAS
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 HERMAN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-9201
Mailing Address - Country:US
Mailing Address - Phone:614-855-0764
Mailing Address - Fax:
Practice Address - Street 1:7600 FODOR RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8738
Practice Address - Country:US
Practice Address - Phone:614-855-8339
Practice Address - Fax:614-855-8328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0017562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer