Provider Demographics
NPI:1780649657
Name:ROGERS, SARAH JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JEAN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-872-0301
Mailing Address - Fax:
Practice Address - Street 1:150 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BIRLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-4670
Practice Address - Fax:802-862-4431
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5666869001OtherCIGNA
VTOVN2167Medicaid
VTVN167Medicare ID - Type Unspecified