Individual
EDWARD ROBERT MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 776-5548
(906) 776-5478
Mailing address
N16564 VINGER LN, PEMBINE, WI 54156-9359
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501011347
MI
Other
Enumeration date
11/24/2018
Last updated
11/24/2018
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