Provider Demographics
NPI:1437442860
Name:RODGERS, NANCY (MASSAGE PRACTIONER)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MASSAGE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 646
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:WA
Mailing Address - Zip Code:98610-0646
Mailing Address - Country:US
Mailing Address - Phone:509-427-5945
Mailing Address - Fax:
Practice Address - Street 1:13 KODIAK WAY
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:WA
Practice Address - Zip Code:98610
Practice Address - Country:US
Practice Address - Phone:509-427-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist