Healthcare Provider Details

I. General information

NPI: 1083530166
Provider Name (Legal Business Name): MIKAYLA ROGERS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10635 SANTA MONICA BLVD STE 165
LOS ANGELES CA
90025-8306
US

IV. Provider business mailing address

6285 E SPRING ST # 550
LONG BEACH CA
90808-4020
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-0877
  • Fax:
Mailing address:
  • Phone: 562-668-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: