MEDICARE: JOHN-MICHAEL MATHIS

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
1	2255A2300X	Athletic Trainer	D11324585	AZ

General Provider Information

NPI Number	:	1356273270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN-MICHAEL MATHIS

Provider Business Mailing Address
First Line	:	3205 E MINERAL PARK RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-4520
Country	:	US
Telephone Number	:	602-412-6094
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 E MINERAL PARK RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-4520
Country	:	US
Telephone Number	:	602-412-6094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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