MEDICARE: ROGER SCOTT WEGLEY PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00003235	WA
2	225100000X	Physical Therapist	PT-26 72	ID
3	225100000X	Physical Therapist	1018	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01689894	OTHER	ID	RR MEDICARE
4	650007475	OTHER	WA	RR MEDICARE
12	P01564222	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0321841	OTHER	WA	WASHINGTON L & I
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0054187	OTHER	WA	WASHINGTON L&I
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0274833	OTHER	WA	WA L & I
11	0330318	OTHER	ID	WA L&I

General Provider Information

NPI Number	:	1306829254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER SCOTT WEGLEY PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	STE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	5420 BARNES AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3839
Country	:	US
Telephone Number	:	206-789-7975
Fax Number	:	206-782-6177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	10/11/2016

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Directions to “ ROGER SCOTT WEGLEY PHYSICAL THERAPIST” Practice Location

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