Provider Demographics
NPI:1558591966
Name:RODGERS, JOSEPH S (LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:RODGERS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 SPRING VILLA CIR
Mailing Address - Street 2:#107
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7516
Mailing Address - Country:US
Mailing Address - Phone:502-235-8658
Mailing Address - Fax:
Practice Address - Street 1:3612 SPRING VILLA CIR
Practice Address - Street 2:#107
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7516
Practice Address - Country:US
Practice Address - Phone:502-235-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist