Individual
MATTHEW JONATHON ROTHSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7320 216TH ST SW STE 320, EDMONDS, WA 98026-8006
(425) 673-3900
(425) 673-3910
Mailing address
19 CASCADE DR, WALLA WALLA, WA 99362-2509
(509) 540-8237
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
60872146
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2110750
—
WA
Enumeration date
09/17/2018
Last updated
11/05/2018
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