Healthcare Provider Details

I. General information

NPI: 1003165283
Provider Name (Legal Business Name): MS. BERNADETTE ROLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W MAITLAND BLVD
MAITLAND FL
32751-4338
US

IV. Provider business mailing address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-3990
  • Fax:
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: