Healthcare Provider Details

I. General information

NPI: 1013428077
Provider Name (Legal Business Name): MERRYN K MATHEW DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N ASHLEY DR UNIT 3209
TAMPA FL
33602-4387
US

IV. Provider business mailing address

2636 GALLAGHER RD
DOVER FL
33527-5304
US

V. Phone/Fax

Practice location:
  • Phone: 813-541-1872
  • Fax: 813-441-8121
Mailing address:
  • Phone: 813-541-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: