Healthcare Provider Details

I. General information

NPI: 1821128182
Provider Name (Legal Business Name): REBECCA LYNN ROLKE ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OWNBY DR BOX 750315
DALLAS TX
75275-0315
US

IV. Provider business mailing address

535 SUMMIT DR
RICHARDSON TX
75081-5134
US

V. Phone/Fax

Practice location:
  • Phone: 214-768-2429
  • Fax: 214-768-1225
Mailing address:
  • Phone: 214-244-4318
  • Fax: 214-768-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: