Provider Demographics
NPI:1003642786
Name:MATHERNE, PEYTON (PT)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:MATHERNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 DOUCET RD STE B2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3403
Mailing Address - Country:US
Mailing Address - Phone:337-991-9972
Mailing Address - Fax:337-991-9974
Practice Address - Street 1:233 DOUCET RD STE B2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3403
Practice Address - Country:US
Practice Address - Phone:337-991-9972
Practice Address - Fax:337-991-9974
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist