Provider Demographics
NPI:1619226065
Name:ROGERS, LEATRICE
Entity Type:Individual
Prefix:
First Name:LEATRICE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 SE COCONUT ST
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4008
Mailing Address - Country:US
Mailing Address - Phone:561-312-3940
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:8108 SE COCONUT ST
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-4008
Practice Address - Country:US
Practice Address - Phone:561-312-3940
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other