Healthcare Provider Details

I. General information

NPI: 1730480518
Provider Name (Legal Business Name): MRS. RUTH FASSIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 SKILLMAN ST SUITE 126
DALLAS TX
75243-8256
US

IV. Provider business mailing address

9560 SKILLMAN ST SUITE 126
DALLAS TX
75243-8256
US

V. Phone/Fax

Practice location:
  • Phone: 214-340-8700
  • Fax: 214-246-1998
Mailing address:
  • Phone: 214-340-8700
  • Fax: 214-246-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number130173
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: