Provider Demographics
NPI:1912043308
Name:ROGERS, KELLY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867
Mailing Address - Country:US
Mailing Address - Phone:603-335-3661
Mailing Address - Fax:603-335-3661
Practice Address - Street 1:231 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-4204
Practice Address - Country:US
Practice Address - Phone:603-335-3661
Practice Address - Fax:603-335-3661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0287M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist