Provider Demographics
NPI:1720094279
Name:MAGSINO, ROGER DANCEL (MPT,OCS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DANCEL
Last Name:MAGSINO
Suffix:
Gender:M
Credentials:MPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6920
Mailing Address - Country:US
Mailing Address - Phone:626-665-2563
Mailing Address - Fax:
Practice Address - Street 1:450 N MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6920
Practice Address - Country:US
Practice Address - Phone:626-665-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27222OtherPT LISCENSE
CAWPT27222AMedicare PIN