Provider Demographics
NPI:1831870591
Name:ROGUE PHYSICAL THERAPY LTD
Entity type:Organization
Organization Name:ROGUE PHYSICAL THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOVENYESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-339-1312
Mailing Address - Street 1:4720 ELM CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1147
Mailing Address - Country:US
Mailing Address - Phone:650-339-1312
Mailing Address - Fax:
Practice Address - Street 1:4720 ELM CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1147
Practice Address - Country:US
Practice Address - Phone:650-339-1312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty