Provider Demographics
NPI:1427535855
Name:RODGERS COOKSEY, MARVA LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARVA
Middle Name:LYNN
Last Name:RODGERS COOKSEY
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 1:946 E 43RD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3025
Mailing Address - Country:US
Mailing Address - Phone:773-855-9142
Mailing Address - Fax:
Practice Address - Street 1:946 E 43RD ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3025
Practice Address - Country:US
Practice Address - Phone:773-855-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.018622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist