Provider Demographics
NPI:1497728000
Name:ROGERSON, THOMAS KIRK (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KIRK
Last Name:ROGERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 JOHNSON MILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5065
Mailing Address - Country:US
Mailing Address - Phone:479-404-4530
Mailing Address - Fax:479-404-4526
Practice Address - Street 1:3561 JOHNSON MILL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5065
Practice Address - Country:US
Practice Address - Phone:479-404-4530
Practice Address - Fax:479-404-4526
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710685433OtherTAX ID
AR5S355OtherBLUE CROSS BLUE SHIELD
AR5S355OtherBLUE CROSS BLUE SHIELD