Basic Information
| Provider Information | |||||||||
| NPI: | 1720400948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | SARAH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5203 AVALON CT | ||||||||
| Address2: | |||||||||
| City: | WEST LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077641059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328592209 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 EAGLE AVE | ||||||||
| Address2: | SEAVIEW ORTHOPEDICS AND MEDICAL ASSOCIATES | ||||||||
| City: | OCEAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326606200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01534200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.