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General NPI Number Information
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NPI Number | 1083014344
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Entity Type | Individual
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Provider Name | TARA ROGERS ATC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2014
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Last Update Date | 08/23/2014
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Provider Practice Location Address
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Address Line | 131 COLLEGE CIR
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City | SWAINSBORO
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State | GA
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Zip | 30401-3643
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Country | US
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Telephone | 424-645-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 2812 DELAWARE AVE
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City | SANTA MONICA
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State | CA
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Zip | 90404-5013
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Country | US
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Telephone | 424-645-4401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002565
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License Number State | GA
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