MEDICARE: MR. AUDIE PADRONES PT, MHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	01506	MO
2	225100000X	Physical Therapist	218371	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	410490	OTHER	MO	GROUP # FOR HEALTHLINK
3	120210	OTHER	MO	GROUP # FOR BC/BS
4	1873945	OTHER	MO	GROUP # FOR FIRST HEALTH

General Provider Information

NPI Number	:	1205884335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUDIE PADRONES PT, MHS

Provider Business Mailing Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 207
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-373-9460
Fax Number	:	907-373-9461

Provider Business Practice Location Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 207
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-373-9460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/17/2024

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