Individual
TARA ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
131 COLLEGE CIR, SWAINSBORO, GA 30401-3643
(424) 645-4401
Mailing address
2812 DELAWARE AVE, SANTA MONICA, CA 90404-5013
(424) 645-4401
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002565
GA
Other
Enumeration date
08/23/2014
Last updated
08/23/2014
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