Provider Demographics
NPI:1245220607
Name:RODGERS, MARTIN DAVID (RPT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:DAVID
Last Name:RODGERS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:870 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2105
Practice Address - Country:US
Practice Address - Phone:413-734-7277
Practice Address - Fax:413-734-7879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0033586OtherNEIGHBORHOOD HEALTH PLAN
MA3443500OtherAETNA
MAY68252OtherBLUECROSS/BLUESHIELD
MA704317OtherCONNECTICARE
MA0323055Medicaid
MA971057OtherNETWORK HEALTH
MA704317OtherCONNECTICARE