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General NPI Number Information
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NPI Number | 1063548980
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Entity Type | Individual
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Provider Name | ROGER D IBURG
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 511 PHYLLIS ST
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City | PENSACOLA
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State | FL
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Zip | 32503-2024
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Country | US
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Telephone | 850-477-8874
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Fax | 850-477-8865
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Provider Business Mailing Address
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Address Line | 511 PHYLLIS ST
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City | PENSACOLA
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State | FL
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Zip | 32503-2024
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Country | US
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Telephone | 850-477-8874
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Fax | 850-477-8865
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 4977
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License Number State | FL
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