Provider Demographics
NPI:1770315236
Name:MATHEW, AMAL MANOJ (DPT)
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:MANOJ
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 ASHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1530
Mailing Address - Country:US
Mailing Address - Phone:214-460-9835
Mailing Address - Fax:
Practice Address - Street 1:13000 JOSEY LN STE 150
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-3670
Practice Address - Country:US
Practice Address - Phone:972-247-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1397554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist