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General NPI Number Information
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NPI Number | 1477697639
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Entity Type | Individual
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Provider Name | ERIC W MATHES ATC
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 E MOUNTAIN DR
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City | WILKES BARRE
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State | PA
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Zip | 18711-0027
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Country | US
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Telephone | 570-825-1093
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Fax |
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Provider Business Mailing Address
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Address Line | 254 BURKE ST
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City | PLAINS
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State | PA
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Zip | 18705-1400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | RT002380A
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License Number State | PA
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