Provider Demographics
NPI:1437795663
Name:AGUIRRE, ROGELIO (DPT)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LUPINE CIR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1701
Mailing Address - Country:US
Mailing Address - Phone:323-875-9764
Mailing Address - Fax:
Practice Address - Street 1:711 LUPINE CIR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1701
Practice Address - Country:US
Practice Address - Phone:323-875-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist