Healthcare Provider Details

I. General information

NPI: 1932208220
Provider Name (Legal Business Name): LESLEY K ROGAN M.ED., PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16976 LILLY PAD DR
MILTON DE
19968-3422
US

IV. Provider business mailing address

16976 LILLY PAD DR
MILTON DE
19968-3422
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-3360
  • Fax: 302-644-1905
Mailing address:
  • Phone: 302-644-3360
  • Fax: 302-644-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000810
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: