Healthcare Provider Details

I. General information

NPI: 1194825232
Provider Name (Legal Business Name): MR. DAVID ROGERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 GULF DR
ANNA MARIA FL
34216
US

IV. Provider business mailing address

PO BOX 844
ANNA MARIA FL
34216-0844
US

V. Phone/Fax

Practice location:
  • Phone: 941-704-3281
  • Fax: 941-778-3523
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: