Provider Demographics
NPI:1508829607
Name:ROGERS, CYNTHIA LYNNE (PT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:ROGERS
Suffix:
Gender:F
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:PO BOX 116
Mailing Address - Street 2:64 JULIA STREET
Mailing Address - City:GRAND RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44045-0116
Mailing Address - Country:US
Mailing Address - Phone:440-352-7124
Mailing Address - Fax:
Practice Address - Street 1:6270 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2567
Practice Address - Country:US
Practice Address - Phone:440-428-8242
Practice Address - Fax:440-428-8243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-7444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist