Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 17240 | MA |
Y | 2251N0400X | Physical Therapist - Neurology | 34627 | CA |
NPI | 1215107115 |
---|---|
Provider Name | Dr. Matthew Audia |
First Address | Carlsbad, CA 92008-8822 |
Second Address | Carlsbad, CA 92008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 08/06/2018 |