Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1154138 | TX |
NPI | 1225241086 |
---|---|
Provider Name | Betsy Thomas Mathew |
First Address | Garland, TX 75040 |
Second Address | Plano, TX 75078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |