Provider Demographics
NPI:1821567215
Name:ROGERS, MATTHEW DYLAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DYLAN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HALL RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5238
Mailing Address - Country:US
Mailing Address - Phone:845-796-8620
Mailing Address - Fax:
Practice Address - Street 1:6325 ROUTE US 209
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-1244
Practice Address - Country:US
Practice Address - Phone:845-647-4171
Practice Address - Fax:845-647-4174
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043918-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist