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General NPI Number Information
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NPI Number | 1427535855
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Entity Type | Individual
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Provider Name | MARVA LYNN RODGERS COOKSEY LMT
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Gender | Female
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 946 E 43RD ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60653-3025
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Country | US
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Telephone | 773-855-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 946 E 43RD ST UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60653-3025
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Country | US
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Telephone | 773-855-9142
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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 | 227.018622
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License Number State | IL
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