Provider Demographics
NPI:1104891878
Name:RODGERS, CRYSTAL MICHELLE (ATC)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 LEE ROAD 145
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-2310
Mailing Address - Country:US
Mailing Address - Phone:334-749-0253
Mailing Address - Fax:
Practice Address - Street 1:30 A & B SAMFORD AVENUE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-742-9266
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL22408OtherNATA
AL893OtherALABAMA ATC LICENSES