Provider Demographics
NPI:1861580011
Name:RODGERS, TONYA M (DPT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:RODGERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 SULKY LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8623
Mailing Address - Country:US
Mailing Address - Phone:303-679-6091
Mailing Address - Fax:
Practice Address - Street 1:1262 BERGEN PKWY
Practice Address - Street 2:STE E10
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9546
Practice Address - Country:US
Practice Address - Phone:303-674-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist