Provider Demographics
NPI:1982239893
Name:ROGGENSACK, SHELBY CASTLE (PTA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:CASTLE
Last Name:ROGGENSACK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1335
Mailing Address - Country:US
Mailing Address - Phone:608-395-1787
Mailing Address - Fax:
Practice Address - Street 1:29 CRAIG AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1335
Practice Address - Country:US
Practice Address - Phone:608-395-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2406-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant