Individual
BRADLEY MARSHAALL ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPA, MPM, DPT
Contact information
Practice address
1400 E 9TH ST, ROCHESTER, IN 46975-8931
(574) 224-1166
Mailing address
3444 W 100 N, PERU, IN 46970-7583
(765) 469-7573
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006737A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1140055509
STATE OF INDIANA
IN
Enumeration date
11/20/2018
Last updated
11/20/2018
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