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General NPI Number Information
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NPI Number | 1124735139
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Entity Type | Individual
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Provider Name | GLORIA VIRGINIA RODGERS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 3100 E CHARLESTON BLVD STE 107
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City | LAS VEGAS
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State | NV
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Zip | 89104-6666
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Country | US
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Telephone | 702-333-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 WENDY LN
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City | LAS VEGAS
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State | NV
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Zip | 89115-0134
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Country | US
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Telephone | 702-592-0551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NVMT1554
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License Number State | NV
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