Provider Demographics
NPI:1740738145
Name:ROGERS, AMY (MT-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 BLACK BUCK TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-1675
Mailing Address - Country:US
Mailing Address - Phone:325-812-1005
Mailing Address - Fax:
Practice Address - Street 1:3513 BLACK BUCK
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-1675
Practice Address - Country:US
Practice Address - Phone:325-812-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07812225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist