Provider Demographics
NPI:1164472973
Name:ROGERS, LAURA (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-1428
Mailing Address - Country:US
Mailing Address - Phone:573-280-4783
Mailing Address - Fax:
Practice Address - Street 1:1870 BAGNELL DAM BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8658
Practice Address - Country:US
Practice Address - Phone:573-964-6010
Practice Address - Fax:573-964-6909
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040193072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer