Basic Information
| Provider Information | |||||||||
| NPI: | 1720691215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ROGERS | ||||||||
| OtherFirstName: | PAIGE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235415492 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 695 N PRESTON RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750093925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723828551 | ||||||||
| FaxNumber: | 9723828553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2020 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1331268 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.