Individual
DEMITRA ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
860 DULUTH HWY STE 152, LAWRENCEVILLE, GA 30043-5336
(678) 886-4759
(678) 886-4759
Mailing address
PO BOX 15145, ATLANTA, GA 30333-0145
(678) 886-4759
(678) 886-4759
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT011640
GA
Other
Enumeration date
03/16/2019
Last updated
06/11/2019
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