Provider Demographics
NPI:1205946159
Name:MATTIX, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MATTIX
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 1:300 W BEECH ST UNIT 2001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8452
Mailing Address - Country:US
Mailing Address - Phone:912-655-0811
Mailing Address - Fax:
Practice Address - Street 1:4031 W PLANO PKWY
Practice Address - Street 2:STE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5619
Practice Address - Country:US
Practice Address - Phone:972-867-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1201019225100000X, 2251X0800X
CAPT296437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 21488OtherLICENSE #
FLPT 21488OtherLICENSE #