Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1579 | FL |
NPI | 1003165283 |
---|---|
Provider Name | Ms. Bernadette Rollins |
First Address | Louisville, KY 40222-5158 |
Second Address | Maitland, FL 32751-4338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 05/09/2012 |