Provider Demographics
NPI:1356536304
Name:ROGSTAD, GARETT F (PT, DPT)
Entity type:Individual
Prefix:
First Name:GARETT
Middle Name:F
Last Name:ROGSTAD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PRAIRIE HEIGHTS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2238
Mailing Address - Country:US
Mailing Address - Phone:608-848-6628
Mailing Address - Fax:608-848-6629
Practice Address - Street 1:411 PRAIRIE HEIGHTS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-2238
Practice Address - Country:US
Practice Address - Phone:608-848-6628
Practice Address - Fax:608-848-6629
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11053-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36182900Medicaid
WI823750006OtherMEDICARE PTAN