Provider Demographics
NPI:1275826083
Name:MITCHELL-ROGERS, PENNY JEAN (LMT, CR)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:JEAN
Last Name:MITCHELL-ROGERS
Suffix:
Gender:F
Credentials:LMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3668
Mailing Address - Country:US
Mailing Address - Phone:413-388-1072
Mailing Address - Fax:
Practice Address - Street 1:54 COURT ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3668
Practice Address - Country:US
Practice Address - Phone:413-388-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARCB-180173C00000X
MA7874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist