Provider Demographics
NPI:1528816014
Name:ROGERS, ALYSON BRIANNA (PTA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:BRIANNA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 STATE ROUTE 136
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9473
Mailing Address - Country:US
Mailing Address - Phone:937-403-8641
Mailing Address - Fax:
Practice Address - Street 1:1114 NEIGHBORHOOD DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2874
Practice Address - Country:US
Practice Address - Phone:513-688-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant