Provider Demographics
NPI:1639510696
Name:ROGERS, LIZA MARIE (MPT, ATC)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ROGERS
Other - Last Name:ROYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 LINWOOD PL
Mailing Address - Street 2:APT 1
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2414
Mailing Address - Country:US
Mailing Address - Phone:207-670-6708
Mailing Address - Fax:
Practice Address - Street 1:194 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1242
Practice Address - Country:US
Practice Address - Phone:978-774-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3307225100000X
MA22687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist