Provider Demographics
NPI:1801923297
Name:ROGGEN, FRANCES (PT, PA)
Entity type:Individual
Prefix:MS
First Name:FRANCES
Middle Name:
Last Name:ROGGEN
Suffix:
Gender:F
Credentials:PT, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINAIR
Mailing Address - State:NM
Mailing Address - Zip Code:87036-0888
Mailing Address - Country:US
Mailing Address - Phone:410-979-6143
Mailing Address - Fax:505-847-3636
Practice Address - Street 1:121 RTE 60
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNTAINAIR
Practice Address - State:NM
Practice Address - Zip Code:87036-0888
Practice Address - Country:US
Practice Address - Phone:410-979-6143
Practice Address - Fax:505-847-3636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16028225100000X
NM3908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM121RMedicare PIN
MD121RMedicare ID - Type UnspecifiedC00901
MDR862OtherCAREFIRST FEDERAL I.D.