Matt Wrathall, CM
Matt Wrathall, CM is an Undefined Non-Physician Type (Specify) in Rexburg, Idaho. Qualified in 2022, 4 years ago. Practices as a sole proprietor. Licensed in Arizona.
- Years since qualifying
- 4
- Licensed in
- AZ
- In the registry since
- 2023
Practice location Address checks out
663 Trejo StRexburg, ID 83440-2579
Phone: (385) 758-4356
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Pain Clinic/Center (primary) | Taxonomy 261QP3300X (AZ) |
|---|
Record details
| NPI number | 1205612405 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | CM |
| Sole proprietor | Yes |
| NPI enumerated | September 4, 2023 |
| Last updated in NPPES | March 16, 2025 |
| Certification date | March 16, 2025 |
| Mailing address | Po Box 151, Menan, ID 83434-0151 |
Medicare enrollment
| Medicare specialty | UNDEFINED NON-PHYSICIAN TYPE (SPECIFY) |
|---|---|
| Medical school | OTHER |
| Graduated | 2022 (4 years in practice) |
| Accepts Medicare assignment | Not indicated |
| Practice locations | 2 on file with Medicare |