Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-02137 | KS |
NPI | 1003122128 |
---|---|
Provider Name | Jennifer S Rollins |
First Address | Wichita, KS 67205-4502 |
Second Address | Wichita, KS 67212-3378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 26/08/2010 |