Provider Demographics
NPI:1851705412
Name:MATHEW, LEJOY (DPT)
Entity Type:Individual
Prefix:
First Name:LEJOY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 RAINTREE CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4957
Mailing Address - Country:US
Mailing Address - Phone:214-383-9939
Mailing Address - Fax:314-383-9929
Practice Address - Street 1:323 LAS COLINAS BLVD E
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-5556
Practice Address - Country:US
Practice Address - Phone:972-401-0300
Practice Address - Fax:972-401-2800
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1242780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist