Provider Demographics
NPI:1972756104
Name:MATHEW, JENCY ANNA (PT)
Entity Type:Individual
Prefix:
First Name:JENCY
Middle Name:ANNA
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SW 107TH AVE
Mailing Address - Street 2:#178
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2526
Mailing Address - Country:US
Mailing Address - Phone:786-395-1187
Mailing Address - Fax:
Practice Address - Street 1:12596 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1766
Practice Address - Country:US
Practice Address - Phone:954-653-3625
Practice Address - Fax:954-620-2267
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist