Provider Demographics
NPI:1932208220
Name:ROGAN, LESLEY K (MED, PT, ATC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:K
Last Name:ROGAN
Suffix:
Gender:F
Credentials:MED, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16976 LILLY PAD DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3422
Mailing Address - Country:US
Mailing Address - Phone:302-644-3360
Mailing Address - Fax:302-644-1905
Practice Address - Street 1:16976 LILLY PAD DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3422
Practice Address - Country:US
Practice Address - Phone:302-644-3360
Practice Address - Fax:302-644-1905
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist