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NPI Code Detail

MEDICARE: MR. THOMAS KIRK ROGERSON P.T.

MEDICARE: MR. THOMAS KIRK ROGERSON P.T.
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
1225100000XPhysical TherapistPT937AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1710685433OTHERARTAX ID
25S355OTHERARBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1497728000
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS KIRK ROGERSON P.T.
Provider Business Mailing Address
First Line : 3561 JOHNSON MILL BLVD STE 201
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72704-5065
Country : US
Telephone Number : 479-404-4530
Fax Number : 479-404-4526
Provider Business Practice Location Address
First Line : 3561 JOHNSON MILL BLVD STE 201
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72704-5065
Country : US
Telephone Number : 479-404-4530
Fax Number : 479-404-4526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 06/22/2021

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