Healthcare Provider Details

I. General information

NPI: 1710046750
Provider Name (Legal Business Name): MATTHEW B ROHAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SEABRIGHT AVE
SANTA CRUZ CA
95062-2528
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-6230
  • Fax:
Mailing address:
  • Phone: 831-458-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: