Provider Demographics
NPI:1174241285
Name:ROGERS, AUBREYROSE J
Entity type:Individual
Prefix:
First Name:AUBREYROSE
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CAVALIER CT APT 504
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6405
Mailing Address - Country:US
Mailing Address - Phone:210-430-6790
Mailing Address - Fax:
Practice Address - Street 1:711 CAVALIER CT APT 504
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6405
Practice Address - Country:US
Practice Address - Phone:210-430-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTMT130080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist