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General NPI Number Information
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NPI Number | 1639611205
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Entity Type | Individual
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Provider Name | MATTHEW ANTHONY D'ELENA DPT
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Gender | Male
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 11/13/2016
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Provider Practice Location Address
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Address Line | 332 PINE ST SUITE 202
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-3206
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Country | US
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Telephone | 415-732-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 E CROCUS AVE
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-5010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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