Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 16008 | CA |
NPI | 1588967434 |
---|---|
Provider Name | Margaret Loretta Roller |
First Address | Northridge, CA 91330-0001 |
Second Address | Northridge, CA 91330-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2010 |
Last Update Date | 15/12/2010 |