Provider Demographics
NPI:1245656420
Name:ROGELIO, FERDINAND REY GARCIA (PT)
Entity type:Individual
Prefix:MR
First Name:FERDINAND REY
Middle Name:GARCIA
Last Name:ROGELIO
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 1:210 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1024
Mailing Address - Country:US
Mailing Address - Phone:856-375-0640
Mailing Address - Fax:
Practice Address - Street 1:235 LUCAS LN
Practice Address - Street 2:APT 12
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2577
Practice Address - Country:US
Practice Address - Phone:856-375-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01470400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist