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1720706492 NPI number — BENJAMIN L ROGERS DPT

NPI Number: 1720706492
Health Care Provider/Practitioner: BENJAMIN L ROGERS DPT

Information about “1720706492” NPI (BENJAMIN L ROGERS DPT) exists in 1720706492 in HTML format HTML  |  1720706492 in plain Text format TXT  |  1720706492 in PDF (Portable Document Format) PDF  |  1720706492 in an XML format XML  formats.

NPI Number : 1720706492 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720706492",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROGERS",
    "FirstName": "BENJAMIN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2122 YORK RD STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK BROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60523-1925",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-575-1980",
    "MailingAddressFaxNumber": "630-928-5080",
    "FirstLinePracticeLocationAddress": "499 GLOSTER CREEK VLG STE F5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUPELO",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "38801-4631",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-841-0551",
    "PracticeLocationAddressFaxNumber": "662-841-0554",
    "EnumerationDate": "08/18/2022",
    "LastUpdateDate": "08/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT7327",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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