Provider Demographics
NPI:1588710743
Name:ROGERS, JAMES WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:WA
Mailing Address - Zip Code:99171-0066
Mailing Address - Country:US
Mailing Address - Phone:509-648-3341
Mailing Address - Fax:509-648-4237
Practice Address - Street 1:13854 STATE ROUTE 23
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:WA
Practice Address - Zip Code:99171-9756
Practice Address - Country:US
Practice Address - Phone:509-648-3341
Practice Address - Fax:509-648-4237
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3038225100000X
MT645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347769Medicaid
WAG8865939Medicare PIN
MT0347769Medicaid