MEDICARE: MR. MATTHEW ANTHONY D'ELENA DPT

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

General Provider Information

NPI Number	:	1639611205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW ANTHONY D'ELENA DPT

Provider Business Mailing Address
First Line	:	1726 E CROCUS AVE
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-5010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 PINE ST
Second Line	:	SUITE 202
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-3206
Country	:	US
Telephone Number	:	415-732-5608
Fax Number	:

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

Provider Enumeration Date	:	11/13/2016
Last Update Date	:	11/13/2016

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