Individual
MR. THOMAS KIRK ROGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3561 JOHNSON MILL BLVD STE 201, FAYETTEVILLE, AR 72704-5065
(479) 404-4530
(479) 404-4526
Mailing address
3561 JOHNSON MILL BLVD STE 201, FAYETTEVILLE, AR 72704-5065
(479) 404-4530
(479) 404-4526
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT937
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S355
BLUE CROSS BLUE SHIELD
AR
01
—
710685433
TAX ID
AR
Enumeration date
02/13/2006
Last updated
06/22/2021
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