Healthcare Provider Details

I. General information

NPI: 1629533369
Provider Name (Legal Business Name): INFINITY LEE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LIVESAY RD
SAND CREEK MI
49279-9702
US

IV. Provider business mailing address

4160 LIVESAY RD
SAND CREEK MI
49279-9702
US

V. Phone/Fax

Practice location:
  • Phone: 517-662-9038
  • Fax:
Mailing address:
  • Phone: 517-662-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: