Individual
MATTHEW RONGSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11200 GOVERNOR MANLY WAY, RALEIGH, NC 27614-8599
(919) 562-9410
Mailing address
4720 SHANNONHOUSE DR APT 110, RALEIGH, NC 27612-3416
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2148
NC
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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