Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 3038 | OR |
Y | 2251P0200X | Physical Therapist - Pediatrics | 6909 | WA |
NPI | 1124378922 |
---|---|
Provider Name | Mrs. Stephanie Gwen Marie Rogers |
First Address | Vancouver, WA 98661-6392 |
Second Address | Vancouver, WA 98661-6392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 19/09/2012 |