Provider Demographics
NPI:1013171974
Name:ROGERS, BURTON LEE JR (EDD, MBA, ATC, LPTA)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:LEE
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:EDD, MBA, ATC, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ARLINGTON AVE
Mailing Address - Street 2:MORSE CENTER DOWLING HALL
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-4000
Mailing Address - Fax:419-383-3085
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:MORSE CENTER DOWLING HALL
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-4000
Practice Address - Fax:419-383-3085
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA1244, AT1932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer