Provider Demographics
NPI:1689013286
Name:ROJO-INGALLA, MARIE JANE (PT,CBIS)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JANE
Last Name:ROJO-INGALLA
Suffix:
Gender:F
Credentials:PT,CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2685
Mailing Address - Country:US
Mailing Address - Phone:989-839-1027
Mailing Address - Fax:
Practice Address - Street 1:2707 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4449
Practice Address - Country:US
Practice Address - Phone:989-631-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist