Provider Demographics
NPI:1750151098
Name:RODGERS, ANNETTE (LMBT)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HALLS STORE RD SW
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:VA
Mailing Address - Zip Code:24380-4984
Mailing Address - Country:US
Mailing Address - Phone:540-695-4107
Mailing Address - Fax:
Practice Address - Street 1:187 N. LOCUST ST.
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-0187
Practice Address - Country:US
Practice Address - Phone:540-695-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist