Provider Demographics
NPI:1629533369
Name:ROGERS, INFINITY LEE
Entity Type:Individual
Prefix:
First Name:INFINITY
Middle Name:LEE
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 1:4160 LIVESAY RD
Mailing Address - Street 2:
Mailing Address - City:SAND CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49279-9702
Mailing Address - Country:US
Mailing Address - Phone:517-662-9038
Mailing Address - Fax:
Practice Address - Street 1:4160 LIVESAY RD
Practice Address - Street 2:
Practice Address - City:SAND CREEK
Practice Address - State:MI
Practice Address - Zip Code:49279-9702
Practice Address - Country:US
Practice Address - Phone:517-662-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer