Provider Demographics
NPI:1861080251
Name:ROGERS, TERRELL LAMONT
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:LAMONT
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 COLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2615
Mailing Address - Country:US
Mailing Address - Phone:937-414-1127
Mailing Address - Fax:
Practice Address - Street 1:1442 COLES BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2615
Practice Address - Country:US
Practice Address - Phone:937-414-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide