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General NPI Number Information
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NPI Number | 1720800592
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Entity Type | Individual
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Provider Name | ALLISYN DANIELLE ROGLIN PTA
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 3141 DALHART DR
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City | FORT WORTH
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State | TX
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Zip | 76179-2663
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Country | US
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Telephone | 851-481-7918
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Fax |
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Provider Business Mailing Address
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Address Line | 10133 CHAPEL OAK TRL
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City | FORT WORTH
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State | TX
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Zip | 76116-1234
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Country | US
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Telephone | 817-907-9718
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2158781
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License Number State | TX
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