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NPI Code Detail

MEDICARE: MATTHEW ANTHONY CONSALVI

MEDICARE: MATTHEW ANTHONY CONSALVI
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
1225100000XPhysical TherapistPT297101CA

General Provider Information

NPI Number : 1396366712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW ANTHONY CONSALVI
Provider Business Mailing Address
First Line : 26600 OSO PKWY APT 249
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-5661
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2725 E BROADWAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-5431
Country : US
Telephone Number : 503-702-9212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2020
Last Update Date : 04/27/2020

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