Provider Demographics
NPI:1730161977
Name:ROGERS, DAVID A (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 W LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-618-3046
Mailing Address - Fax:
Practice Address - Street 1:650 GRAHAM RD
Practice Address - Street 2:107
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1052
Practice Address - Country:US
Practice Address - Phone:330-920-1002
Practice Address - Fax:330-920-0923
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT3977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT03977OtherOHIO BOARD OF PT OT AND A