Provider Demographics
NPI:1346473147
Name:RODEHEAVER, ROSLYN E (LMT)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:E
Last Name:RODEHEAVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 KEMPER LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-8046
Mailing Address - Country:US
Mailing Address - Phone:859-548-5057
Mailing Address - Fax:
Practice Address - Street 1:3104 KEMPER LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8046
Practice Address - Country:US
Practice Address - Phone:859-548-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist