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NPI Code Detail

MEDICARE: MRS. LAURA ROGERS LAT, ATC

MEDICARE: MRS. LAURA ROGERS LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2004019307MO

General Provider Information

NPI Number : 1164472973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA ROGERS LAT, ATC
Provider Business Mailing Address
First Line : 203 W HIGH ST
Second Line :
City : ELDON
State : MO
Zip : 65026-1428
Country : US
Telephone Number : 573-280-4783
Fax Number :
Provider Business Practice Location Address
First Line : 1870 BAGNELL DAM BLVD
Second Line : SUITE B
City : LAKE OZARK
State : MO
Zip : 65049-8658
Country : US
Telephone Number : 573-964-6010
Fax Number : 573-964-6909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA ROGERS LAT, ATC” Practice Location

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