Provider Demographics
NPI:1750488185
Name:ROGERS, PAUL E (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 GLOHAVEN DR.
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-2387
Mailing Address - Fax:501-327-2387
Practice Address - Street 1:814 NORTH CREEK DR.
Practice Address - Street 2:SUITE B
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-327-0000
Practice Address - Fax:501-327-0070
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W346Medicare ID - Type UnspecifiedPHYSICAL THERAPIST