Healthcare Provider Details

I. General information

NPI: 1669968483
Provider Name (Legal Business Name): KATHLEEN ROGERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ALAMEDA AVE
SALINAS CA
93901-4120
US

IV. Provider business mailing address

PO BOX 1612
SOLEDAD CA
93960-1612
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-1878
  • Fax:
Mailing address:
  • Phone: 570-351-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: