Provider Demographics
NPI:1841599503
Name:MATHEW, SOFIA ROWTHER (PA-C)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:ROWTHER
Last Name:MATHEW
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 1:2500 WEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5851
Mailing Address - Country:US
Mailing Address - Phone:817-423-4400
Mailing Address - Fax:817-423-8080
Practice Address - Street 1:1300 W TERRELL AVE STE 500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2810
Practice Address - Country:US
Practice Address - Phone:817-252-5000
Practice Address - Fax:817-252-5086
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152196Medicare PIN
TXTXB152194Medicare PIN
TXTXB152195Medicare PIN