Individual
MARY ANN MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
R1183
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34255016
BLUE CROSS BLUE SHIELD
MO
05
—
485768717
—
MO
01
—
7332708
AETNA
MO
01
—
P00246846
RAIL ROAD MEDICARE
MO
Enumeration date
06/13/2006
Last updated
03/25/2013
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