Healthcare Provider Details

I. General information

NPI: 1053676569
Provider Name (Legal Business Name): AMBER RENAE ROGERS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 E CATALINA CT
CORNVILLE AZ
86325-5097
US

IV. Provider business mailing address

4945 E CATALINA CT
CORNVILLE AZ
86325-5097
US

V. Phone/Fax

Practice location:
  • Phone: 480-225-0454
  • Fax:
Mailing address:
  • Phone: 480-225-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9121
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: