Provider Demographics
NPI:1770804775
Name:ROSIN, MATTHEW L (PTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:ROSIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37943 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-4067
Mailing Address - Country:US
Mailing Address - Phone:608-385-8372
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5061
Practice Address - Country:US
Practice Address - Phone:407-833-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant