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NPI Code Detail

MEDICARE: JOSHUA MATTISON

MEDICARE: JOSHUA MATTISON
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
1225100000XPhysical Therapist13468MN

General Provider Information

NPI Number : 1013757764
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA MATTISON
Provider Business Mailing Address
First Line : 3100 19TH ST NW STE 200
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-6606
Country : US
Telephone Number : 507-322-3460
Fax Number :
Provider Business Practice Location Address
First Line : 4229 W FRONTAGE RD N
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-4310
Country : US
Telephone Number : 507-322-3460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2024
Last Update Date : 12/11/2024

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Directions to “ JOSHUA MATTISON ” Practice Location

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