Provider Demographics
NPI:1073937975
Name:ROGERS, TINA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
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 1:11041 N 137TH ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1022
Mailing Address - Country:US
Mailing Address - Phone:402-786-2626
Mailing Address - Fax:
Practice Address - Street 1:11041 N 137TH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1022
Practice Address - Country:US
Practice Address - Phone:402-786-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE337314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility