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NPI Code Detail

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

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
1225100000XPhysical Therapist10266MN

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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Directions to “ DR. MATTHEW MYCHAL ZELLMER PT, DPT, ATR, CSCS” Practice Location

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