Provider Demographics
NPI:1386885259
Name:RODGERS, KRISTIN J
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:J
Last Name:RODGERS
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 1:6701 W UNION HILLS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8067
Mailing Address - Country:US
Mailing Address - Phone:602-881-2398
Mailing Address - Fax:
Practice Address - Street 1:6701 W UNION HILLS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8067
Practice Address - Country:US
Practice Address - Phone:602-881-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist