Healthcare Provider Details

I. General information

NPI: 1073998951
Provider Name (Legal Business Name): CHRISTOPHER ROGERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 WOODS CT
HOOD RIVER OR
97031-2915
US

IV. Provider business mailing address

1627 WOODS CT
HOOD RIVER OR
97031-2915
US

V. Phone/Fax

Practice location:
  • Phone: 541-386-9511
  • Fax: 866-860-8070
Mailing address:
  • Phone: 541-386-9511
  • Fax: 866-860-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-10162822
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: