Provider Demographics
NPI:1851412712
Name:ROGGEVEEN, LEONARD PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:PAUL
Last Name:ROGGEVEEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:LEONARD
Other - Middle Name:PAUL
Other - Last Name:ROGGEVEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:502 REDBIRD RUN
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9310
Mailing Address - Country:US
Mailing Address - Phone:319-430-4960
Mailing Address - Fax:
Practice Address - Street 1:502 REDBIRD RUN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-9310
Practice Address - Country:US
Practice Address - Phone:319-430-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist