Provider Demographics
NPI:1528066636
Name:ROGERS, BRIAN JAMES (MPT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W ROUND BUNCH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2344
Mailing Address - Country:US
Mailing Address - Phone:409-697-3718
Mailing Address - Fax:409-697-3963
Practice Address - Street 1:1010 W ROUND BUNCH RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2342
Practice Address - Country:US
Practice Address - Phone:409-697-3718
Practice Address - Fax:409-697-3963
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11334522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00887YMedicare ID - Type UnspecifiedGROUP NUMBER