Healthcare Provider Details

I. General information

NPI: 1780649657
Provider Name (Legal Business Name): SARAH JEAN ROGERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KENNEDY DR
SOUTH BIRLINGTON VT
05403
US

IV. Provider business mailing address

59 SAYBROOK RD
ESSEX JUNCTION VT
05452
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-4670
  • Fax: 802-862-4431
Mailing address:
  • Phone: 802-872-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400003395
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: