MEDICARE: MR. MATTHEW RYAN ROCKELMAN

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	225200000X	Physical Therapy Assistant	2010037290	MO

General Provider Information

NPI Number	:	1912267576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW RYAN ROCKELMAN

Provider Business Mailing Address
First Line	:	5780 OSAGE BEACH PKWY
Second Line	:	220
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5780 OSAGE BEACH PKWY
Second Line	:	220
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3188
Country	:	US
Telephone Number	:	573-693-9128
Fax Number	:

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

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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Directions to “ MR. MATTHEW RYAN ROCKELMAN ” Practice Location

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