Healthcare Provider Details

I. General information

NPI: 1548591795
Provider Name (Legal Business Name): MATTHEW OAKES MS ED., ATC-L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LAC DE VILLE BLVD UNIVERSITY OF ROCHESTER SPORTS MEDICINE
ROCHESTER NY
14618-5647
US

IV. Provider business mailing address

19 OAKLAND ST
ROCHESTER NY
14620-2332
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-9150
  • Fax:
Mailing address:
  • Phone: 585-397-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number67 001600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: