Provider Demographics
NPI:1316257744
Name:ROGERS, MICHELLE K (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:K
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 FOREST OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1929
Mailing Address - Country:US
Mailing Address - Phone:434-534-1913
Mailing Address - Fax:434-534-1913
Practice Address - Street 1:110 FOREST OAKS DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-1929
Practice Address - Country:US
Practice Address - Phone:434-534-1913
Practice Address - Fax:434-534-1913
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604308225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306604308OtherSTATE OF VIRGINIA BOARD OF PHYSICAL THERAPY