Provider Demographics
NPI:1013729045
Name:ROGERS, JOSEPH BLAKE (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BLAKE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 RANKIN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6928
Mailing Address - Country:US
Mailing Address - Phone:870-219-1828
Mailing Address - Fax:
Practice Address - Street 1:1809 E PARKER RD STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7854
Practice Address - Country:US
Practice Address - Phone:870-219-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant