MEDICARE: LORRAINE ANDREWS ROLLER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 7827	CA

General Provider Information

NPI Number	:	1124194147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE ANDREWS ROLLER PT

Provider Business Mailing Address
First Line	:	132 MARINER GREEN CT
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-2014
Country	:	US
Telephone Number	:	415-924-0649
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 REDWOOD BLVD
Second Line	:	#200
City	:	NOVATO
State	:	CA
Zip	:	94945-3250
Country	:	US
Telephone Number	:	415-893-4143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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