Basic Information
| Provider Information | |||||||||
| NPI: | 1962509844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | TERESA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 681 CARNATION PL | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930369045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027822777 | ||||||||
| FaxNumber: | 2027823764 | ||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED ARMY MEDICAL CENTER ORTHO AND REHAB DEPT | ||||||||
| Address2: | 6900 GEORGIA AVE, NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027822777 | ||||||||
| FaxNumber: | 2027823764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 21814 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.