Provider Demographics
NPI:1457966194
Name:MATHELIER, THIERRY
Entity Type:Individual
Prefix:
First Name:THIERRY
Middle Name:
Last Name:MATHELIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8740 FRANCIS LEWIS BLVD APT A63
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2844
Mailing Address - Country:US
Mailing Address - Phone:718-749-1275
Mailing Address - Fax:
Practice Address - Street 1:8740 FRANCIS LEWIS BLVD APT A63
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2844
Practice Address - Country:US
Practice Address - Phone:718-749-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019437-01225700000X
NY01943701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty