Provider Demographics
NPI:1376940858
Name:RODGERS, KELCI GRIER (PTA)
Entity Type:Individual
Prefix:
First Name:KELCI
Middle Name:GRIER
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241
Mailing Address - Country:US
Mailing Address - Phone:318-547-4300
Mailing Address - Fax:
Practice Address - Street 1:155 N DEAN RD
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-7951
Practice Address - Country:US
Practice Address - Phone:318-547-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant