Provider Demographics
NPI:1740552678
Name:ROGERS, EMILY (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:456 REMINGTON PT
Mailing Address - Street 2:APT 206
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8067
Mailing Address - Country:US
Mailing Address - Phone:503-407-4284
Mailing Address - Fax:
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-736-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004201A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant