Provider Demographics
NPI:1649688334
Name:MATEO, DEXTER P (PT)
Entity type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:P
Last Name:MATEO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4651
Mailing Address - Country:US
Mailing Address - Phone:724-557-2563
Mailing Address - Fax:
Practice Address - Street 1:1811 MAYFIELD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4651
Practice Address - Country:US
Practice Address - Phone:724-557-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist