Provider Demographics
NPI:1194476416
Name:ROGERS, REBECCA (LMT, MMP, CMCP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMT, MMP, CMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-7733
Mailing Address - Country:US
Mailing Address - Phone:903-221-3685
Mailing Address - Fax:
Practice Address - Street 1:1000 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-7733
Practice Address - Country:US
Practice Address - Phone:903-221-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT128487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty