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General NPI Number Information
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NPI Number | 1669788634
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Entity Type | Individual
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Provider Name | MIKE B. MATHEWS L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 600 LAKEVIEW RD SUITE E
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City | CLEARWATER
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State | FL
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Zip | 33756-3355
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Country | US
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Telephone | 727-647-9481
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 SAXONY CT E
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City | CLEARWATER
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State | FL
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Zip | 33761-1730
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Country | US
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Telephone | 727-647-9481
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA59189
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License Number State | FL
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