Basic Information
| Provider Information | |||||||||
| NPI: | 1912095183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | ALBERT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2718 E 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992236605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092522354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2718 E 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992236605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092522354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT00008943 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | PT516 | 01 | ID | BLUE CROSS OF IDAHO | OTHER | 0211510 | 01 | WA | WASHINGTON L & I | OTHER | 000010157485 | 01 | ID | REGENCE BLUE SHIELD | OTHER |