MEDICARE: DR. MATTHEW AUDIA PT, DPT, CMP

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	225100000X	Physical Therapist	17240	MA
2	2251N0400X	Neurology Physical Therapist	34627	CA

General Provider Information

NPI Number	:	1215107115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW AUDIA PT, DPT, CMP

Provider Business Mailing Address
First Line	:	5963 LA PLACE CT STE 109
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-8822
Country	:	US
Telephone Number	:	617-669-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	5963 LA PLACE CT STE 109
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	617-669-1071
Fax Number	:

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	06/08/2018

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