Provider Demographics
NPI:1659820934
Name:ROSEWAG, MATTHEW T (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:ROSEWAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 SIGNAL BELL LN
Mailing Address - Street 2:STE 200
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2606
Mailing Address - Country:US
Mailing Address - Phone:410-730-3399
Mailing Address - Fax:443-478-4726
Practice Address - Street 1:8186 LARK BROWN RD
Practice Address - Street 2:STE 201
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6434
Practice Address - Country:US
Practice Address - Phone:410-730-3399
Practice Address - Fax:443-478-4726
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2017-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD19977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist