Healthcare Provider Details

I. General information

NPI: 1689588444
Provider Name (Legal Business Name): ISABELLA RENAE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 SQUAW PRAIRIE RD
BELVIDERE IL
61008-8800
US

IV. Provider business mailing address

3242 N MERIDIAN RD
STILLMAN VALLEY IL
61084-9754
US

V. Phone/Fax

Practice location:
  • Phone: 815-544-9495
  • Fax:
Mailing address:
  • Phone: 815-990-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.020597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: