Kelly Ann Rogers, PTA, LMT, BS
Individual provider Active NPI Physical Therapy Assistant · Byron, IL
NPI 1578893723 · NPPES record last updated Jan 12, 2010
Key facts
- NPI
- 1578893723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.005347 (IL)
- Practice address
- 404 West Blackhawk Drive
Suite 1LL
Byron, IL 61010 - Phone
- (815) 234-5561
- Fax
- (815) 234-5870
- NPI assigned
- Jan 12, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.005347 | IL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ogle County Physical Therapy Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.005347 | IL | Yes |
Addresses
Primary practice location
404 West Blackhawk Drive
Suite 1LL
Byron, IL 61010
Mailing address
404 West Blackhawk Drive
Suite 1LL
Byron, IL 61010
Phone (815) 234-5561
Other providers in Byron, IL
- Shanairra C Quinn
- Rahn Family Wellness Center, LLC
- Troy A. Rahn
- RMJ Partnership
- Emily Rogers
- Carissa Rognstad
- Brittney Faustine Semple
- Shady Oak Dental - Byron Dental LLC
- Katharine Anne Sherburne
- Sinnissippi Centers, Inc.
All providers in Byron, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.