Healthcare Provider Details

I. General information

NPI: 1962658849
Provider Name (Legal Business Name): ALISON L ROGOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9935 RED ARROW HWY
BRIDGMAN MI
49106-9002
US

IV. Provider business mailing address

112 LAUREL ST.
LAPORTE IN
46350-2658
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-3017
  • Fax:
Mailing address:
  • Phone: 219-575-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: