Provider Demographics
NPI:1164630240
Name:HAUGEN, ROXANN VERONICA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROXANN
Middle Name:VERONICA
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ROXANN
Other - Middle Name:VERONICA
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 2860
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-2860
Mailing Address - Country:US
Mailing Address - Phone:575-439-1397
Mailing Address - Fax:
Practice Address - Street 1:126 S CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5733
Practice Address - Country:US
Practice Address - Phone:575-628-0503
Practice Address - Fax:575-628-3073
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0574225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant