Provider Demographics
NPI:1225835838
Name:KAUL, MATTHEW ALAN (PTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:KAUL
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29856 N YELLOW BEE DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3985
Mailing Address - Country:US
Mailing Address - Phone:480-720-6455
Mailing Address - Fax:
Practice Address - Street 1:21083 N JOHN WAYNE PKWY STE C104
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2961
Practice Address - Country:US
Practice Address - Phone:520-233-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ014175225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant