Provider Demographics
NPI:1720705684
Name:ROGERS, MARY F (LMT, RNBSN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMT, RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8045
Mailing Address - Country:US
Mailing Address - Phone:334-270-9340
Mailing Address - Fax:
Practice Address - Street 1:7114 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8045
Practice Address - Country:US
Practice Address - Phone:334-270-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist