Healthcare Provider Details

I. General information

NPI: 1023941028
Provider Name (Legal Business Name): NICHOLE MARIE RODGERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 FAIRWAY VIEW PL
RANCHO CUCAMONGA CA
91730-0932
US

IV. Provider business mailing address

503 CALLE MONTEREY
SAN DIMAS CA
91773-3943
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-7345
  • Fax:
Mailing address:
  • Phone: 626-422-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: