Provider Demographics
NPI:1497444244
Name:ROGERS, KATIE ELIZABETH (CMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 OUR PEAK RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9445
Mailing Address - Country:US
Mailing Address - Phone:707-357-1797
Mailing Address - Fax:
Practice Address - Street 1:11610 OUR PEAK RD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9445
Practice Address - Country:US
Practice Address - Phone:707-357-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist