Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TEI000357 | PA |
NPI | 1003426842 |
---|---|
Provider Name | Sandra Rolles |
First Address | Etters, PA 17319-8868 |
Second Address | Mechanicsburg, PA 17055-6171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 06/08/2020 |