Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2006007771 | MO |
NPI | 1003383001 |
---|---|
Provider Name | Lisa Fran Rolwes |
First Address | Creve Coeur, MO 63141-7016 |
Second Address | Creve Coeur, MO 63141-7016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2018 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006007771 | LICENSE NUMBER (01) | MO |