Provider Demographics
NPI:1720709991
Name:UNCHAINED PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:UNCHAINED PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC, CMTPT
Authorized Official - Phone:574-286-3439
Mailing Address - Street 1:26650 SAINT ANNS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9256
Mailing Address - Country:US
Mailing Address - Phone:574-286-3439
Mailing Address - Fax:
Practice Address - Street 1:26650 SAINT ANNS CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9256
Practice Address - Country:US
Practice Address - Phone:574-286-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty