Provider Demographics
NPI:1578859294
Name:ROGERS, HEATHER MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HEATHET
Other - Middle Name:MARIE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:716 N 119TH ST W
Mailing Address - Street 2:STE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1938
Mailing Address - Country:US
Mailing Address - Phone:316-721-1900
Mailing Address - Fax:
Practice Address - Street 1:716 N 119TH ST W
Practice Address - Street 2:STE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1938
Practice Address - Country:US
Practice Address - Phone:316-721-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist