MEDICARE: TRACI L ROGERS PHYSICAL THERAPY, P. C.

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
1	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1417127762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACI L ROGERS PHYSICAL THERAPY, P. C.

Provider Business Mailing Address
First Line	:	2105 SPRING RIDGE CT
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-7807
Country	:	US
Telephone Number	:	502-836-8222
Fax Number	:	812-796-0116

Provider Business Practice Location Address
First Line	:	2105 SPRING RIDGE CT
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-7807
Country	:	US
Telephone Number	:	502-836-8222
Fax Number	:	812-796-0116

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	TRACI FALBO
Credential	:
Telephone Number	:	502-836-8222

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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