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General NPI Number Information
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NPI Number | 1194375808
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Entity Type | Individual
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Provider Name | COLLEEN KATHRYN ROGERS ATC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2019
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Last Update Date | 09/14/2019
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Provider Practice Location Address
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Address Line | 1609 VINEYARD MIST DR
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City | CARY
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State | NC
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Zip | 27519-6998
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Country | US
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Telephone | 919-475-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 VINEYARD MIST DR
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City | CARY
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State | NC
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Zip | 27519-6998
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Country | US
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Telephone | 919-475-4613
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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 | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 2601001916
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License Number State | MI
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