Individual
STACY MATHIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
24 TEKE BURTON DR, MITCHELL, IN 47446-7360
(812) 849-2221
Mailing address
612 1/2 SW 2ND STREET, LOOGOOTEE, IN 47553
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003241A
IN
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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