Provider Demographics
NPI:1942324124
Name:RODGERS, JASON MICHAEL (MS PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 SIDON RD
Mailing Address - Street 2:
Mailing Address - City:ROSE BUD
Mailing Address - State:AR
Mailing Address - Zip Code:72137-9771
Mailing Address - Country:US
Mailing Address - Phone:501-593-2707
Mailing Address - Fax:707-202-3865
Practice Address - Street 1:257 SIDON RD
Practice Address - Street 2:
Practice Address - City:ROSE BUD
Practice Address - State:AR
Practice Address - Zip Code:72137-9771
Practice Address - Country:US
Practice Address - Phone:501-593-2707
Practice Address - Fax:707-202-3865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140796721Medicaid
AR140796721Medicaid