Provider Demographics
NPI:1386162261
Name:MATHIEU, BRIAN VICTOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:VICTOR
Last Name:MATHIEU
Suffix:
Gender:M
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 1:475 QUAKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-3602
Mailing Address - Country:US
Mailing Address - Phone:207-576-8864
Mailing Address - Fax:
Practice Address - Street 1:1607 ATLANTIC HWY
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6023
Practice Address - Country:US
Practice Address - Phone:207-832-5544
Practice Address - Fax:207-832-5507
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist