Provider Demographics
NPI:1871141184
Name:SACLA, ROGER JONATHAN
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JONATHAN
Last Name:SACLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 17 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2801
Mailing Address - Country:US
Mailing Address - Phone:586-286-7100
Mailing Address - Fax:585-285-0802
Practice Address - Street 1:17001 17 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2801
Practice Address - Country:US
Practice Address - Phone:586-286-7100
Practice Address - Fax:586-286-0802
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist