Provider Demographics
NPI:1750645867
Name:MATHIS, JANICE MARIE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3307
Mailing Address - Country:US
Mailing Address - Phone:702-221-6224
Mailing Address - Fax:702-221-9752
Practice Address - Street 1:4435 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3307
Practice Address - Country:US
Practice Address - Phone:702-221-6224
Practice Address - Fax:702-221-9752
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner