Healthcare Provider Details

I. General information

NPI: 1881379980
Provider Name (Legal Business Name): MATTHEW C. ESPANOL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 AUGUSTA CT
DISCOVERY BAY CA
94505-9286
US

IV. Provider business mailing address

5680 AUGUSTA CT
DISCOVERY BAY CA
94505-9286
US

V. Phone/Fax

Practice location:
  • Phone: 415-967-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: