Provider Demographics
NPI:1215107115
Name:AUDIA, MATTHEW (PT, DPT, CMP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:AUDIA
Suffix:
Gender:M
Credentials:PT, DPT, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 LA PLACE CT STE 109
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8822
Mailing Address - Country:US
Mailing Address - Phone:617-669-1071
Mailing Address - Fax:
Practice Address - Street 1:5963 LA PLACE CT STE 109
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:617-669-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17240225100000X
CA346272251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist