Provider Demographics
NPI:1821853466
Name:RODGERS, PATRICK K (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:K
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 1:12700 SW NORTH DAKOTA ST STE 180
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-0802
Mailing Address - Country:US
Mailing Address - Phone:503-716-8281
Mailing Address - Fax:503-716-8783
Practice Address - Street 1:12700 SW NORTH DAKOTA ST STE 180
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-0802
Practice Address - Country:US
Practice Address - Phone:503-716-8281
Practice Address - Fax:503-716-8783
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty