Provider Demographics
NPI:1205250370
Name:RALEIGH, ROGER JAMES (MSPT)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:JAMES
Last Name:RALEIGH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5904
Mailing Address - Country:US
Mailing Address - Phone:954-557-6554
Mailing Address - Fax:954-975-9632
Practice Address - Street 1:3349 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5904
Practice Address - Country:US
Practice Address - Phone:954-557-6554
Practice Address - Fax:954-975-9632
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist