Basic Information
Provider Information
NPI: 1326591983
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROGERS
FirstName: ANDREW
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W GERMANTOWN PIKE
Address2: SUITE 100
City: PLYMOUTH MEETING
State: PA
PostalCode: 194621420
CountryCode: US
TelephoneNumber: 6102700370
FaxNumber: 6102700374
Practice Location
Address1: 466 GERMANTOWN PIKE
Address2: SUITE 200
City: LAFAYETTE HILL
State: PA
PostalCode: 194441805
CountryCode: US
TelephoneNumber: 6108327510
FaxNumber: 6108325964
Other Information
ProviderEnumerationDate: 08/01/2016
LastUpdateDate: 08/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800XPT025419PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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