| Doctor Name: | AUDRA PONCI BADO |
| NPI Number: | 1164627436 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.P.T. |
| License Number: | 26768 |
| Business Practice Address: | 615 N Nash St Ste # 306 El Segundo, CA - 902452825 |
| Business Phone Number: | 3105350008 |
| Business Fax Number: | |
| Mailing Address: | 615n Nash St 306, EL SEGUNDO |
| State: | CA |
| Postal Code: | 902452850 |
| Phone Number: | 3105350008 |
| Fax Number: | 3105350009 |
| NPI Enumeration Date: | 06/18/2007 |
| NPI Last Update Date: | 09/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 26768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |