Healthcare Provider Details

I. General information

NPI: 1578027280
Provider Name (Legal Business Name): LORETTA ANN RODGERS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 310
GILBERT AZ
85234-2465
US

IV. Provider business mailing address

2451 E BASELINE RD STE 310
GILBERT AZ
85234-2465
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-1398
  • Fax:
Mailing address:
  • Phone: 602-639-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-13966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: