Provider Demographics
NPI:1912018664
Name:ROGERS, KAREN (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
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 1:3003 W CASINO RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1910
Mailing Address - Country:US
Mailing Address - Phone:425-965-2868
Mailing Address - Fax:425-965-2917
Practice Address - Street 1:3003 W CASINO RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-1910
Practice Address - Country:US
Practice Address - Phone:425-965-2868
Practice Address - Fax:425-965-2917
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA197932OtherLABOR & INDUSTRIES
WA8395626Medicaid
WA50-6570Medicare ID - Type UnspecifiedMEDICARE