Active NPI
Daphne Matildo, P.T.
- Physical Therapist
- Southgate, MI
National Provider Identifier
1306902168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501012453
- Practice address
- 12855 Dix Toledo Rd
Southgate, MI 48195-1744 - Phone
- (734) 283-2526
- NPI assigned
- Dec 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501012453 | MI | Primary |
Addresses
Primary practice location
12855 Dix Toledo Rd
Southgate, MI 48195-1744
Mailing address
13200 Village Park Dr
Apt 1041
Southgate, MI 48195-2758
Phone (219) 741-2546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501012453 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306902168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13200 VILLAGE PARK DR",
"address_2": "APT 1041",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952758",
"telephone_number": "219-741-2546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12855 DIX TOLEDO RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481951744",
"telephone_number": "734-283-2526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATILDO",
"first_name": "DAPHNE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501012453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.