Provider Demographics
NPI:1285496976
Name:CHESTNUT, ROGER DEVIN II (MMP)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DEVIN
Last Name:CHESTNUT
Suffix:II
Gender:M
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 N CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9382
Mailing Address - Country:US
Mailing Address - Phone:843-325-6391
Mailing Address - Fax:
Practice Address - Street 1:2132 N CHANDLER DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9382
Practice Address - Country:US
Practice Address - Phone:843-325-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13277021-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist