MEDICARE: DR. MATTHEW MYCHAL ZELLMER PT, DPT, ATR, CSCS

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
1	225100000X	Physical Therapist	10266	MN

General Provider Information

NPI Number	:	1942659719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MYCHAL ZELLMER PT, DPT, ATR, CSCS

Provider Business Mailing Address
First Line	:	401 SIBLEY ST
Second Line	:	APT. 539
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-1942
Country	:	US
Telephone Number	:	507-440-3327
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 WILDWOOD RD
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1812
Country	:	US
Telephone Number	:	651-429-9947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2016
Last Update Date	:	06/12/2016

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