=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659994564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ROGERS DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2020
-----------------------------------------------------
Last Update Date | 06/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2632 GRANT LINE RD
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47150-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-944-9048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1825 AUGUSTA BLVD
-----------------------------------------------------
City | HENRYVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47126-0078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-252-7088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 12860
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05013743A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------