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General NPI Number Information
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NPI Number | 1508590878
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Entity Type | Individual
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Provider Name | AVERY ELIZABETH ROGERS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 315 E WILSON ST
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City | WINGATE
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State | NC
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Zip | 28174-9665
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Country | US
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Telephone | 850-559-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 9909 TURTLE DOVE
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City | TALLAHASSEE
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State | FL
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Zip | 32312-4024
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Country | US
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Telephone | 850-559-0419
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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 |
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License Number State |
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