Provider Demographics
NPI:1144412578
Name:FUGLEBERG, ROXANA (PT)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:FUGLEBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 BELLA ROSA LN UNIT 107
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-8309
Mailing Address - Country:US
Mailing Address - Phone:703-901-1180
Mailing Address - Fax:
Practice Address - Street 1:6095 BELLA ROSA LN UNIT 107
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-8309
Practice Address - Country:US
Practice Address - Phone:703-901-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist