Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 225100000X | Physical Therapist | 40QA01998800 | NJ |
N | 225100000X | Physical Therapist | PT029280 | PA |
N | 2251S0007X | Physical Therapist - Sports | 40QA01998800 | NJ |
N | 2251S0007X | Physical Therapist - Sports | PT029280 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA01998800 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | PT029280 | PA |
NPI | 1154915536 |
---|---|
Provider Name | Dr. Tara Rogers |
First Address | Bala Cynwyd, PA 19004-1848 |
Second Address | Glassboro, NJ 08028-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2021 |
Last Update Date | 15/03/2021 |