Provider Demographics
NPI:1477001998
Name:ROGERS, KRISTEN (ATC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5224
Mailing Address - Country:US
Mailing Address - Phone:805-404-7557
Mailing Address - Fax:
Practice Address - Street 1:493 APPLETON RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5224
Practice Address - Country:US
Practice Address - Phone:805-404-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000014039OtherBOC