Provider Demographics
NPI:1598562506
Name:ROGGE, CHANTEL ROSE (LMT)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:ROSE
Last Name:ROGGE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-0141
Mailing Address - Country:US
Mailing Address - Phone:715-404-0292
Mailing Address - Fax:
Practice Address - Street 1:2310 N MOLTER RD STE 108
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8621
Practice Address - Country:US
Practice Address - Phone:509-924-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61552298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist