1700187002 NPI number — MS. GAELYN STASSE ROGERS D.P.T.

Table of content: MS. GAELYN STASSE ROGERS D.P.T. (NPI 1700187002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700187002 NPI number — MS. GAELYN STASSE ROGERS D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
GAELYN
Provider Middle Name:
STASSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700187002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 OLIVE CHAPEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27502-8586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-535-8758
Provider Business Mailing Address Fax Number:
919-535-3271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 CROSSROAD HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28716-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-492-0592
Provider Business Practice Location Address Fax Number:
828-492-0593
Provider Enumeration Date:
11/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  62 033243 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: P16170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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