Provider Demographics
NPI:1457168296
Name:ROGERS, ASHLEY CHANEL (LPTA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:CHANEL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1937
Mailing Address - Country:US
Mailing Address - Phone:757-403-4501
Mailing Address - Fax:
Practice Address - Street 1:5838 HARBOUR VIEW BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2698
Practice Address - Country:US
Practice Address - Phone:757-673-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605383225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant