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NPI Code Detail

MEDICARE: MATHEW GEORGE

MEDICARE: MATHEW GEORGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501013098MI

General Provider Information

NPI Number : 1093218570
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATHEW GEORGE
Provider Business Mailing Address
First Line : 43259 VINTNERS PLACE DR
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48314-1334
Country : US
Telephone Number : 586-215-7911
Fax Number :
Provider Business Practice Location Address
First Line : 3500 SOUTH BLVD W
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-3973
Country : US
Telephone Number : 248-852-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 03/12/2018

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