Provider Demographics
NPI:1114100849
Name:ROGERS, JASON W (MPT, MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:4420 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4700
Practice Address - Country:US
Practice Address - Phone:425-315-9500
Practice Address - Fax:425-315-0585
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ06025Medicare UPIN
WAG8800448Medicare PIN