Provider Demographics
NPI:1114440252
Name:RODGERS, MARIA (BA, EIS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:BA, EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 HAMMOCK RIDGE RD APT 5202
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6383
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S HIGHWAY 27 STE B201
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6816
Practice Address - Country:US
Practice Address - Phone:135-239-4021
Practice Address - Fax:352-394-0212
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist