Healthcare Provider Details

I. General information

NPI: 1871774588
Provider Name (Legal Business Name): LIANNE KA'UILANI ROGERS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 W KEATING AVE
MESA AZ
85202-7321
US

IV. Provider business mailing address

2217 W KEATING AVE
MESA AZ
85202-7321
US

V. Phone/Fax

Practice location:
  • Phone: 480-216-0019
  • Fax:
Mailing address:
  • Phone: 480-216-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7904
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: