Healthcare Provider Details

I. General information

NPI: 1942324124
Provider Name (Legal Business Name): JASON MICHAEL RODGERS MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 SIDON RD
ROSE BUD AR
72137-9771
US

IV. Provider business mailing address

257 SIDON RD
ROSE BUD AR
72137-9771
US

V. Phone/Fax

Practice location:
  • Phone: 501-593-2707
  • Fax: 707-202-3865
Mailing address:
  • Phone: 501-593-2707
  • Fax: 707-202-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2441
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: