Healthcare Provider Details

I. General information

NPI: 1194634758
Provider Name (Legal Business Name): LOIS E MATHEWS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 ABERDEEN CIR
TEMPLE TERRACE FL
33617-7812
US

IV. Provider business mailing address

704 ABERDEEN CIR
TEMPLE TERRACE FL
33617-7812
US

V. Phone/Fax

Practice location:
  • Phone: 813-503-6568
  • Fax:
Mailing address:
  • Phone: 813-503-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: