Provider Demographics
NPI:1821384462
Name:ALLEN, MATTHEW ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:STE. 106
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-723-8337
Practice Address - Fax:760-723-5476
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0281334OtherDEPT. OF LABOR AND INDUSTRIES
CAFE399XMedicare PIN
CAW14904Medicare PIN
WA0281334OtherDEPT. OF LABOR AND INDUSTRIES
CAFE399YMedicare PIN