Provider Demographics
NPI:1306944392
Name:ROGERS, JOHN M (CPED)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 N PINE ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3151
Mailing Address - Country:US
Mailing Address - Phone:864-583-4452
Mailing Address - Fax:864-582-2728
Practice Address - Street 1:1000 N PINE ST
Practice Address - Street 2:SUITE 19
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3151
Practice Address - Country:US
Practice Address - Phone:864-583-4452
Practice Address - Fax:864-582-2728
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2516Medicaid
SC5233840001Medicare ID - Type Unspecified