Provider Demographics
NPI:1841806650
Name:ROGERS, SASHA DANIELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SASHA
Middle Name:DANIELLE
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 1:3512 GRADY ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-7235
Mailing Address - Country:US
Mailing Address - Phone:469-226-4427
Mailing Address - Fax:
Practice Address - Street 1:4230 LYNDON B JOHNSON FWY # 200N
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5806
Practice Address - Country:US
Practice Address - Phone:469-226-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT177990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist