Provider Demographics
NPI:1225082605
Name:ROGERS, TERESA A (MSPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N RAMPART BLVD # 135
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-242-3352
Mailing Address - Fax:
Practice Address - Street 1:3355 SPRING MOUNTAIN RD STE 23
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8627
Practice Address - Country:US
Practice Address - Phone:702-570-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicare ID - Type UnspecifiedPENDING