Individual
MATT WRATHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CM
Contact information
Practice address
663 TREJO ST, REXBURG, ID 83440-2579
(385) 758-4356
Mailing address
PO BOX 151, MENAN, ID 83434-0151
(385) 758-4356
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
AZ
Other
Enumeration date
09/04/2023
Last updated
03/16/2025
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