Healthcare Provider Details

I. General information

NPI: 1134907181
Provider Name (Legal Business Name): BAUDENDISTEL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 MISSION AVE STE C
CARMICHAEL CA
95608-2955
US

IV. Provider business mailing address

3609 MISSION AVE STE C
CARMICHAEL CA
95608-2955
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-4681
  • Fax: 916-487-4687
Mailing address:
  • Phone: 916-487-4681
  • Fax: 916-487-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW J BAUDENDISTEL
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 916-487-4681