Provider Demographics
NPI:1114625951
Name:ROGERS, CODY A (PT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 LINWOOD DR STE F
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7224
Mailing Address - Country:US
Mailing Address - Phone:870-239-8099
Mailing Address - Fax:870-239-5091
Practice Address - Street 1:4000 LINWOOD DR STE F
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7224
Practice Address - Country:US
Practice Address - Phone:870-239-8099
Practice Address - Fax:870-239-5091
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist