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General NPI Number Information
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NPI Number | 1588638340
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Entity Type | Individual
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Provider Name | MELANIE DAWN ROGERS PTA
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Gender | Female
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 115 S SALEM DR
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City | BARDSTOWN
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State | KY
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Zip | 40004-1762
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Country | US
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Telephone | 502-350-0880
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Fax | 502-350-3640
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Provider Business Mailing Address
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Address Line | 2264 LYONS STATION RD
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City | NEW HAVEN
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State | KY
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Zip | 40051
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Country | US
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Telephone | 502-549-5994
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A02071
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License Number State | KY
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