Provider Demographics
NPI:1083912349
Name:ROGERS, THERESA STARKS (PBT(ASCP))
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:STARKS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PBT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3775
Mailing Address - Country:US
Mailing Address - Phone:406-454-3247
Mailing Address - Fax:406-454-0718
Practice Address - Street 1:1201 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3775
Practice Address - Country:US
Practice Address - Phone:406-454-3247
Practice Address - Fax:406-454-0718
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT457247200000X
246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other