Provider Demographics
NPI:1952420143
Name:ROGERS, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E AVENUE J8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5669
Mailing Address - Country:US
Mailing Address - Phone:661-726-9907
Mailing Address - Fax:
Practice Address - Street 1:1609 E PALMDALE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4881
Practice Address - Country:US
Practice Address - Phone:661-947-1595
Practice Address - Fax:661-575-1682
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner