Provider Demographics
NPI:1487984449
Name:RODGERS, HEATHER RENAE (PT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENAE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SEA CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2824
Mailing Address - Country:US
Mailing Address - Phone:760-277-3325
Mailing Address - Fax:
Practice Address - Street 1:1005 SEA CLIFF WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2824
Practice Address - Country:US
Practice Address - Phone:760-277-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist