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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANN MATHOT PT

MEDICARE: MRS. KIMBERLY ANN MATHOT PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician7513MN

General Provider Information

NPI Number : 1629550025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANN MATHOT PT
Provider Business Mailing Address
First Line : 4503 3RD ST NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-3120
Country : US
Telephone Number : 507-450-7918
Fax Number :
Provider Business Practice Location Address
First Line : 24 8TH ST NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-6817
Country : US
Telephone Number : 507-424-4027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2018
Last Update Date : 08/31/2018

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Directions to “ MRS. KIMBERLY ANN MATHOT PT” Practice Location

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