Provider Demographics
NPI:1336876879
Name:ROGERS, KYLE STEVEN (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:ROGERS
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 1:446 INDEPENDENCE HILLS VLG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2547
Mailing Address - Country:US
Mailing Address - Phone:304-838-4257
Mailing Address - Fax:
Practice Address - Street 1:1509 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2135
Practice Address - Country:US
Practice Address - Phone:304-363-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist