Healthcare Provider Details

I. General information

NPI: 1205825114
Provider Name (Legal Business Name): JOSEPH SCOTT ROGERS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09461
GB

IV. Provider business mailing address

PSC 47 BOX 798
APO AE
09470
GB

V. Phone/Fax

Practice location:
  • Phone: 011441638528124
  • Fax:
Mailing address:
  • Phone: 011441480434004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1052462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: