Provider Demographics
NPI:1093516817
Name:MATHIEU, LYNN P (CTRS)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:MATHIEU
Suffix:
Gender:
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 SHARPCREST ST APT M1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5965
Mailing Address - Country:US
Mailing Address - Phone:281-796-5295
Mailing Address - Fax:
Practice Address - Street 1:1475 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5900
Practice Address - Country:US
Practice Address - Phone:281-925-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA84105225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist