Provider Demographics
NPI:1073574950
Name:ROGERS, TAMMY MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 NORTHPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154
Mailing Address - Country:US
Mailing Address - Phone:937-444-2933
Mailing Address - Fax:937-444-2924
Practice Address - Street 1:716 HARRY SAUNER BLVD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-4949
Practice Address - Fax:937-393-4737
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2282060Medicaid
OH2282060Medicaid