Provider Demographics
NPI:1003397670
Name:RODGERS, JONATHAN MAXWELL (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MAXWELL
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SECTION LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6483
Mailing Address - Country:US
Mailing Address - Phone:501-359-3802
Mailing Address - Fax:501-359-3803
Practice Address - Street 1:321 SECTION LINE RD STE E
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6483
Practice Address - Country:US
Practice Address - Phone:501-359-3802
Practice Address - Fax:501-359-3802
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4543OtherARKANSAS PHYSICAL THERAPY BOARD