Provider Demographics
NPI:1922400027
Name:ROGERS, EVELYN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:EVELYN
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 1:158 NAPOLEON ST STE 303
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5557
Mailing Address - Country:US
Mailing Address - Phone:219-464-4321
Mailing Address - Fax:
Practice Address - Street 1:158 NAPOLEON ST STE 303
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5557
Practice Address - Country:US
Practice Address - Phone:219-464-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist