Provider Demographics
NPI:1124825484
Name:MATHERNE, MICHAELA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MATHERNE
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300A UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1032
Mailing Address - Country:US
Mailing Address - Phone:737-237-0046
Mailing Address - Fax:512-792-2936
Practice Address - Street 1:300A UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1032
Practice Address - Country:US
Practice Address - Phone:737-237-0046
Practice Address - Fax:512-792-2936
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11980208100000X
TXCP042470T208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation