Provider Demographics
NPI:1851329478
Name:STROH, ROGER JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JOSEPH
Last Name:STROH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 40TH AVE S STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4501
Mailing Address - Country:US
Mailing Address - Phone:701-293-7294
Mailing Address - Fax:701-282-9738
Practice Address - Street 1:4674 40TH AVE S STE A
Practice Address - Street 2:SUITE 1
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-293-7294
Practice Address - Fax:701-282-9738
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND025172OtherBLUE SHEILD ND
ND9401132OtherPHCS
NDA65191045383OtherPREFERRED ONE
NDHP55856OtherHEALTHPARTNERS
ND6405943OtherSELECTCARE
ND6405943OtherMEDICA
NDP00291055Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN650001431Medicare ID - Type UnspecifiedMEDICARE B INDIVIDUAL
ND9401132OtherPHCS