Provider Demographics
NPI:1700187002
Name:ROGERS, GAELYN STASSE (DPT)
Entity Type:Individual
Prefix:MS
First Name:GAELYN
Middle Name:STASSE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1801 OLIVE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8586
Mailing Address - Country:US
Mailing Address - Phone:919-535-8758
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:90 CROSSROAD HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3703
Practice Address - Country:US
Practice Address - Phone:828-492-0592
Practice Address - Fax:828-492-0593
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY62 033243225100000X
NCP16170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400038242Medicare UPIN