Provider Demographics
NPI:1710046750
Name:ROHAN, MATTHEW B (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:ROHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:2901 PARK AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-706-2085
Practice Address - Fax:831-471-3799
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00447076OtherMC RAILROAD PIN
CAPT25629OtherSTATE LICENSE
CA0PT256290OtherBLUE SHIELD PIN NUMBER
CAP00447076OtherMC RAILROAD PIN