Provider Demographics
NPI:1114798410
Name:ROGERS, TAMISHA (RT)
Entity Type:Individual
Prefix:
First Name:TAMISHA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODMERE DR APT D
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2144
Mailing Address - Country:US
Mailing Address - Phone:804-319-9683
Mailing Address - Fax:
Practice Address - Street 1:727 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1274
Practice Address - Country:US
Practice Address - Phone:434-348-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
VA0117003787227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool