Provider Demographics
NPI:1548402522
Name:THRONEBURG, ROGER ALLEN SR (BCHAS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALLEN
Last Name:THRONEBURG
Suffix:SR
Gender:M
Credentials:BCHAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 S SUNCOAST BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2601
Mailing Address - Country:US
Mailing Address - Phone:352-628-9909
Mailing Address - Fax:
Practice Address - Street 1:3944 S SUNCOAST BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2601
Practice Address - Country:US
Practice Address - Phone:352-628-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2937237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist