Provider Demographics
NPI:1336801992
Name:MATHEWS, DANIEL J (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MATHEWS
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 1:22 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-7822
Mailing Address - Country:US
Mailing Address - Phone:912-247-1661
Mailing Address - Fax:
Practice Address - Street 1:600 COOPER DR STE 130
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3979
Practice Address - Country:US
Practice Address - Phone:972-442-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1353377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist