Provider Demographics
NPI:1073940128
Name:ROGERS, EMILY ROBERTS (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROBERTS
Last Name:ROGERS
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 1:1275 SADLER WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3171
Mailing Address - Country:US
Mailing Address - Phone:907-374-0992
Mailing Address - Fax:907-374-0986
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:STE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3171
Practice Address - Country:US
Practice Address - Phone:907-374-0992
Practice Address - Fax:907-374-0986
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist