Healthcare Provider Details

I. General information

NPI: 1912095183
Provider Name (Legal Business Name): MATTHEW ALBERT ROGERS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 E 57TH AVE
SPOKANE WA
99223-6605
US

IV. Provider business mailing address

2718 E 57TH AVE
SPOKANE WA
99223-6605
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-2354
  • Fax:
Mailing address:
  • Phone: 509-252-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00008943
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: