Provider Demographics
NPI:1154642270
Name:ROGERS, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ENID ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1208
Mailing Address - Country:US
Mailing Address - Phone:713-880-4400
Mailing Address - Fax:713-869-8637
Practice Address - Street 1:3500 W DAVIS ST STE 150B
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1811
Practice Address - Country:US
Practice Address - Phone:936-494-3777
Practice Address - Fax:936-494-3788
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist