Provider Demographics
NPI:1841787819
Name:ROGERS, DENISE MICHELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W DELLA ST
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-6423
Mailing Address - Country:US
Mailing Address - Phone:520-336-8159
Mailing Address - Fax:
Practice Address - Street 1:49 MAIN ST #1164
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-8560
Practice Address - Country:US
Practice Address - Phone:520-336-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT16206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist