Provider Demographics
NPI:1588638340
Name:ROGERS, MELANIE DAWN (PTA)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 LYONS STATION RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051
Mailing Address - Country:US
Mailing Address - Phone:502-549-5994
Mailing Address - Fax:
Practice Address - Street 1:115 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1762
Practice Address - Country:US
Practice Address - Phone:502-350-0880
Practice Address - Fax:502-350-3640
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant