Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1224622 | TX |
NPI | 1356973275 |
---|---|
Provider Name | Sunil Mathew |
First Address | Grapevine, TX 76051-4251 |
Second Address | Grapevine, TX 76051-4251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2020 |
Last Update Date | 08/02/2020 |