Provider Demographics
NPI:1013408426
Name:RODAK, MATTHEW (BA RRT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:RODAK
Suffix:
Gender:M
Credentials:BA RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 CANVASBACK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-8994
Mailing Address - Country:US
Mailing Address - Phone:720-203-5869
Mailing Address - Fax:
Practice Address - Street 1:7823 CANVASBACK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-8994
Practice Address - Country:US
Practice Address - Phone:720-203-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORTL.00032962279G0305X, 2279S1500X, 2279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
No2279G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeriatric Care
No2279S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredSNF/Subacute Care