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General NPI Number Information
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NPI Number | 1295100766
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Entity Type | Organization
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Legal Business Name | ROGUE HEALTH LLC
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 2596 E BARNETT RD STE B
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-727-1996
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 E BARNETT RD # E-125
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City | MEDFORD
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State | OR
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Zip | 97504-4301
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Country | US
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Telephone | 541-727-1996
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Fax |
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Authorized Official
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Title or Position | OWNER / LMT
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Name | MS. THERESE HOLLIDAY
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Credential | LMT, CCA
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Telephone | 541-727-1996
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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 | 18016
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5044
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License Number State | OR
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