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NPI Code Detail

MEDICARE: PHUONG QUOC MATHIAS PTA

MEDICARE: PHUONG QUOC MATHIAS PTA
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
1225200000XPhysical Therapy Assistant117691MO

General Provider Information

NPI Number : 1407920523
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHUONG QUOC MATHIAS PTA
Provider Business Mailing Address
First Line : 2831 JAMES CHRISTOPHER DR
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-4217
Country : US
Telephone Number : 314-770-0904
Fax Number :
Provider Business Practice Location Address
First Line : 2920 FEE FEE RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-1915
Country : US
Telephone Number : 314-291-0121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/08/2007

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