Provider Demographics
NPI:1295853489
Name:MATTHEWS, NDIDIAMAKA DILLIBE (DPT, NCS)
Entity type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:DILLIBE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 ELDORA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3613
Mailing Address - Country:US
Mailing Address - Phone:213-924-4377
Mailing Address - Fax:323-224-7075
Practice Address - Street 1:582 ELDORA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3613
Practice Address - Country:US
Practice Address - Phone:213-924-4377
Practice Address - Fax:323-224-7075
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT274342251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology