Provider Demographics
NPI:1588906721
Name:ROGERS, WILLIAM TEMPLE NEWING (ATC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TEMPLE NEWING
Last Name:ROGERS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 FOOTBALL DR
Mailing Address - Street 2:HALAS HALL AT CONWAY PARK
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-4829
Mailing Address - Country:US
Mailing Address - Phone:847-739-5400
Mailing Address - Fax:847-295-8953
Practice Address - Street 1:1920 FOOTBALL DR
Practice Address - Street 2:HALAS HALL AT CONWAY PARK
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4829
Practice Address - Country:US
Practice Address - Phone:847-739-5400
Practice Address - Fax:847-295-8953
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960025462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer