Individual
MR. MATTHEW LEE DEBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11015 YALUMBA PASS, ROANOKE, IN 46783-8931
(260) 402-1968
Mailing address
11015 YALUMBA PASS, ROANOKE, IN 46783-8931
(260) 402-1968
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10320
CA
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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