Healthcare Provider Details

I. General information

NPI: 1225835838
Provider Name (Legal Business Name): MATTHEW ALAN KAUL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21083 N JOHN WAYNE PKWY STE C104
MARICOPA AZ
85139-2961
US

IV. Provider business mailing address

29856 N YELLOW BEE DR
SAN TAN VALLEY AZ
85143-3985
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-7555
  • Fax:
Mailing address:
  • Phone: 480-720-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: