Provider Demographics
NPI:1962509844
Name:RODGERS, MARILYN TERESA (PT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:TERESA
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:681 CARNATION PL
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9045
Mailing Address - Country:US
Mailing Address - Phone:202-782-2777
Mailing Address - Fax:202-782-3764
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER ORTHO AND REHAB DEPT
Practice Address - Street 2:6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-2777
Practice Address - Fax:202-782-3764
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist