Individual provider · Type 1 NPI
Matt Wrathall, CM
Pain Clinic/Center · Rexburg, ID
NPI number
1205612405
Active
Practice location
663 Trejo St
Rexburg, ID 83440-2579
Mailing address
PO Box 151
Menan, ID 83434-0151
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pain Clinic/Center Primary | 261QP3300X | None listed |
Pain Clinic/Center: Definition to come...
About NPI 1205612405
Matt Wrathall, CM's National Provider Identifier is 1205612405, issued on Sep 4, 2023. The primary taxonomy on file is Pain Clinic/Center (261QP3300X), and the practice location is in Rexburg, ID. The record was last updated on Mar 16, 2025.