Doctor Name: | ILICIA MATHIS |
NPI Number: | 1770951956 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 010594 |
Business Practice Address: | 2285 Whitney Ave Hamden, CT - 065183514 |
Business Phone Number: | 2036916248 |
Business Fax Number: | 2036919239 |
Mailing Address: | 1 Bradley Rd Ste 801, WOODBRIDGE |
State: | CT |
Postal Code: | 065252296 |
Phone Number: | 2033894593 |
Fax Number: | 2033894609 |
NPI Enumeration Date: | 09/04/2015 |
NPI Last Update Date: | 09/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 010594 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |