Provider Demographics
NPI:1902524143
Name:ROGERS, WESLEY S (LMT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:S
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMT
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:210-840-0078
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:210-840-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118145225700000X
TXMT118145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist