Basic Information
| Provider Information | |||||||||
| NPI: | 1386687259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362757405 | ||||||||
| FaxNumber: | 3362755346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362757405 | ||||||||
| FaxNumber: | 3362755346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7325 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.