Provider Demographics
NPI:1336137447
Name:ROGERS, KEELY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-0398
Mailing Address - Country:US
Mailing Address - Phone:870-847-3777
Mailing Address - Fax:870-856-4327
Practice Address - Street 1:31 CHOCTAW CENTER
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-2702
Practice Address - Country:US
Practice Address - Phone:870-856-4325
Practice Address - Fax:870-856-4327
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2418225100000X
ARPT 2418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142606721Medicaid
AR5X070OtherARKANSAS BLUE CROSS
AR5X070Medicare ID - Type Unspecified