Provider Demographics
NPI:1255462537
Name:GOBLE, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:GOBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23133 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE206
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3268
Mailing Address - Country:US
Mailing Address - Phone:248-888-6800
Mailing Address - Fax:
Practice Address - Street 1:23133 ORCHARD LAKE RD
Practice Address - Street 2:SUITE206
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-888-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750046Medicare PIN