Provider Demographics
NPI:1306829254
Name:WEGLEY, ROGER SCOTT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:SCOTT
Last Name:WEGLEY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:5420 BARNES AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3839
Practice Address - Country:US
Practice Address - Phone:206-789-7975
Practice Address - Fax:206-782-6177
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003235225100000X
IDPT-26 72225100000X
OR1018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306829254Medicaid
IDP01689894OtherRR MEDICARE
ID1306829254 - 000Medicaid
WA650007475OtherRR MEDICARE
WA0321841OtherWASHINGTON L & I
OR500630816Medicaid
WA8334864Medicaid
WA0054187OtherWASHINGTON L&I
WA1039348Medicaid
WA0274833OtherWA L & I
ID0330318OtherWA L&I
WAP01564222OtherRR MEDICARE
ORR159179Medicare PIN
ORR160253Medicare PIN
WAAB10181Medicare PIN
ORR159198Medicare PIN
WAP01564222OtherRR MEDICARE
WA0321841OtherWASHINGTON L & I
WA0054187OtherWASHINGTON L&I
WAG8957899Medicare PIN
ORR160266Medicare PIN
OR500630816Medicaid
WAG8890521Medicare PIN
ORR160261Medicare PIN
ORR160272Medicare PIN
WAR160278Medicare PIN
IDP01689894OtherRR MEDICARE
WA650007475OtherRR MEDICARE
ORR158313Medicare PIN