Healthcare Provider Details

I. General information

NPI: 1790744985
Provider Name (Legal Business Name): TERI A ROGERS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33315 SANTIAGO RD
ACTON CA
93510
US

IV. Provider business mailing address

3831 E AVE T8
PALMDALE CA
93550
US

V. Phone/Fax

Practice location:
  • Phone: 661-269-2020
  • Fax: 661-269-2120
Mailing address:
  • Phone: 661-285-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number06000370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: