Provider Demographics
NPI:1275150336
Name:ROGERS, FORREST (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ADDLESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3607
Mailing Address - Country:US
Mailing Address - Phone:864-567-9996
Mailing Address - Fax:
Practice Address - Street 1:900 JOHNNIE DODDS BLVD # 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6130
Practice Address - Country:US
Practice Address - Phone:843-606-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist