Individual
KYLE THOMAS MATHESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013561A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05013561A
INDIANA MEDICAL LICENSE
IN
Enumeration date
09/04/2019
Last updated
09/04/2019
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