Healthcare Provider Details

I. General information

NPI: 1356273270
Provider Name (Legal Business Name): JOHN-MICHAEL MATHIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 E MINERAL PARK RD
SAN TAN VALLEY AZ
85143-4520
US

IV. Provider business mailing address

3205 E MINERAL PARK RD
SAN TAN VALLEY AZ
85143-4520
US

V. Phone/Fax

Practice location:
  • Phone: 602-412-6094
  • Fax:
Mailing address:
  • Phone: 602-412-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberD11324585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: