Provider Demographics
NPI:1972807055
Name:ROGERS, REBECCA ELLEN (MA, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELLEN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ELLEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:621 CHELTEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1319
Mailing Address - Country:US
Mailing Address - Phone:267-269-4741
Mailing Address - Fax:
Practice Address - Street 1:4003 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1401
Practice Address - Country:US
Practice Address - Phone:267-269-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000946133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist