Healthcare Provider Details

I. General information

NPI: 1952314957
Provider Name (Legal Business Name): VALLIE JO ROGERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALLIE JO HOERNING PT

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST SUITE 1
MOUNTAIN GROVE MO
65711-1025
US

IV. Provider business mailing address

PO BOX 702
MOUNTAIN GROVE MO
65711-0702
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-5699
  • Fax: 417-926-5703
Mailing address:
  • Phone: 417-926-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number107429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: