Provider Demographics
NPI:1205884335
Name:PADRONES, AUDIE (PT, MHS)
Entity type:Individual
Prefix:MR
First Name:AUDIE
Middle Name:
Last Name:PADRONES
Suffix:
Gender:M
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 E MERIDIAN PARK LOOP STE 207
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7422
Mailing Address - Country:US
Mailing Address - Phone:907-373-9460
Mailing Address - Fax:907-373-9461
Practice Address - Street 1:3190 E MERIDIAN PARK LOOP STE 207
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7422
Practice Address - Country:US
Practice Address - Phone:907-373-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01506174400000X
AK218371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO483897104Medicaid
MO410490OtherGROUP # FOR HEALTHLINK
MO120210OtherGROUP # FOR BC/BS
MO1873945OtherGROUP # FOR FIRST HEALTH