Individual
MRS. JACQUELINE ROEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
6201 S INTERCON WAY, BOISE, ID 83716-7042
(570) 780-5005
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5763
ID
Other
Enumeration date
06/08/2018
Last updated
12/21/2020
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