Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306605719 | VA |
NPI | 1003482852 |
---|---|
Provider Name | Shannon Rogers |
First Address | Emporia, VA 23847-1248 |
Second Address | Emporia, VA 23847-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |