Provider Demographics
NPI:1396079448
Name:ROGERS, KELLY MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 YORK RD
Mailing Address - Street 2:STE 19
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6210
Mailing Address - Country:US
Mailing Address - Phone:410-296-9195
Mailing Address - Fax:410-296-9197
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:STE 19
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-296-9195
Practice Address - Fax:410-296-9197
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist