Edward Robert Mathis

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501011347 Issued in MI

Practice address

1721 S Stephenson Ave
Iron Mountain, MI 49801-3637

Phone

(906) 776-5548

Fax

(906) 776-5478

NPI assigned

Nov 24, 2018

Last updated

Nov 24, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dickinson County Healthcare System

  dba Marshfield Medical Center - Dickinson Niagara Rehab Center

  • Rehabilitation Clinic/Center
  • Niagara, WI
  • NPI 1043892003

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543017600000",
    "number": "1750850418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N16564 VINGER LN",
            "city": "PEMBINE",
            "state": "WI",
            "postal_code": "541569359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 S STEPHENSON AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013637",
            "telephone_number": "906-776-5548",
            "fax_number": "906-776-5478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "EDWARD",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-24",
        "last_updated": "2018-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501011347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Occhietti, MD, PC
• Mark R. Young, Inc. (Resolving Concerns)
• Mark Allen Martello, LCSW
• Melanie Marie Martin, RN
• John Michael Mastie, RRT
• Christopher Mattas, RRT
• Erika Mattson
• Michael Matwyuk, LMSW
• Laura Maude
• Natasha M Maule-Tekampe

• Physical Therapist in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.