Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2021325 | TX |
NPI | 1003122425 |
---|---|
Provider Name | Gail Ann Mathieu |
First Address | Plano, TX 75075-8511 |
Second Address | Dallas, TX 75243-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2010 |
Last Update Date | 23/08/2010 |