Provider Demographics
NPI:1245926252
Name:ECLEVIA, MATTHEW JOHN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:ECLEVIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 SALK AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7383
Mailing Address - Country:US
Mailing Address - Phone:949-606-3830
Mailing Address - Fax:
Practice Address - Street 1:2173 SALK AVE STE 250
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7383
Practice Address - Country:US
Practice Address - Phone:949-606-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist