Provider Demographics
NPI:1053433078
Name:ROGOL, IAN MICHAEL (ATC)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:MICHAEL
Last Name:ROGOL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 WYTHEVILLE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:434-242-2318
Mailing Address - Fax:
Practice Address - Street 1:1301 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-654-1872
Practice Address - Fax:540-654-1892
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer