Provider Demographics
NPI:1942866843
Name:ROGERS, DANIELE G
Entity Type:Individual
Prefix:
First Name:DANIELE
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61721-9204
Mailing Address - Country:US
Mailing Address - Phone:309-706-6622
Mailing Address - Fax:
Practice Address - Street 1:1450 CASTLE MANOR DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-6006
Practice Address - Country:US
Practice Address - Phone:217-735-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant