Provider Demographics
NPI:1164498705
Name:ROGERS, SHARON DALE (PHD, ATC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DALE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23888-3004
Mailing Address - Country:US
Mailing Address - Phone:757-653-7395
Mailing Address - Fax:
Practice Address - Street 1:1233 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:VA
Practice Address - Zip Code:23888-3004
Practice Address - Country:US
Practice Address - Phone:757-653-7395
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer