MEDICARE: BRIAN VICTOR MATHIEU PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT4926	ME

General Provider Information

NPI Number	:	1386162261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN VICTOR MATHIEU PT, DPT

Provider Business Mailing Address
First Line	:	475 QUAKER RIDGE RD
Second Line	:
City	:	GREENE
State	:	ME
Zip	:	04236-3602
Country	:	US
Telephone Number	:	207-576-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 ATLANTIC HWY
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6023
Country	:	US
Telephone Number	:	207-832-5544
Fax Number	:	207-832-5507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

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