MEDICARE: LORI ROGERS LMP, PTA

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	225700000X	Massage Therapist	MT049232	TX

General Provider Information

NPI Number	:	1578885802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ROGERS LMP, PTA

Provider Business Mailing Address
First Line	:	5445 BASSWOOD BLVD
Second Line	:	STE. 680
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 BASSWOOD BLVD
Second Line	:	STE. 680
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4437
Country	:	US
Telephone Number	:	817-770-0017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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