Healthcare Provider Details

I. General information

NPI: 1598608937
Provider Name (Legal Business Name): NIKKIA D ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7407 WILLOW RD
FREDERICK MD
21702-2595
US

IV. Provider business mailing address

1336 TANEY AVE APT 302
FREDERICK MD
21702-4243
US

V. Phone/Fax

Practice location:
  • Phone: 301-644-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: