MEDICARE: MS. LORY ROLLER

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	2251G0304X	Geriatric Physical Therapist	4279	AZ

General Provider Information

NPI Number	:	1356743215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORY ROLLER

Provider Business Mailing Address
First Line	:	7671 N PLACITA DE LOS AMIGOS
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-2044
Country	:	US
Telephone Number	:	520-444-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	6367 E TANQUE VERDE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3829
Country	:	US
Telephone Number	:	520-721-8800
Fax Number	:

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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