MEDICARE: CHANTEL ROSE ROGGE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	61552298	WA

General Provider Information

NPI Number	:	1598562506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL ROSE ROGGE LMT

Provider Business Mailing Address
First Line	:	PO BOX 141
Second Line	:
City	:	RATHDRUM
State	:	ID
Zip	:	83858-0141
Country	:	US
Telephone Number	:	715-404-0292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 N MOLTER RD STE 108
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8621
Country	:	US
Telephone Number	:	509-924-4443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2025

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Directions to “ CHANTEL ROSE ROGGE LMT” Practice Location

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