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General NPI Number Information
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NPI Number | 1669074514
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Entity Type | Organization
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Legal Business Name | ROGUE PROSTHETICS, LLC
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Dates
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Enumeration Date | 11/14/2020
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 1821 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3105
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Country | US
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Telephone | 936-225-3339
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Fax | 936-571-0599
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Provider Business Mailing Address
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Address Line | 1821 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3105
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Country | US
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Telephone | 936-225-3339
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Fax | 936-571-0599
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Authorized Official
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Title or Position | CEO
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Name | SHERI HATT
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Credential | LPO, MHI
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Telephone | 936-225-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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