MEDICARE: ROGEND DIMAYUGA

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	1314189	TX

General Provider Information

NPI Number	:	1922563196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGEND DIMAYUGA

Provider Business Mailing Address
First Line	:	1983 OAKWELL FARMS PKWY APT 1606
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1766
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 WURZBACH RD STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4332
Country	:	US
Telephone Number	:	210-737-8090
Fax Number	:

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

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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Directions to “ ROGEND DIMAYUGA ” Practice Location

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