Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT297406 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT297406 | CA |
NPI | 1134579394 |
---|---|
Provider Name | Matthew Griffis |
First Address | Oceanside, CA 92054-2417 |
Second Address | Oceanside, CA 92054-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 06/12/2019 |