Healthcare Provider Details

I. General information

NPI: 1801923297
Provider Name (Legal Business Name): FRANCES ROGGEN PT, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RTE 60 SUITE 103
MOUNTAINAIR NM
87036-0888
US

IV. Provider business mailing address

PO BOX 888
MOUNTAINAIR NM
87036-0888
US

V. Phone/Fax

Practice location:
  • Phone: 410-979-6143
  • Fax: 505-847-3636
Mailing address:
  • Phone: 410-979-6143
  • Fax: 505-847-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16028
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3908
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: