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General NPI Number Information
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NPI Number | 1093235772
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Entity Type | Individual
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Provider Name | JAZMINE CYNICE ROLAND ATC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 269 S CANDY LN
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4158
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Country | US
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Telephone | 928-639-6383
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Fax | 928-639-6326
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Provider Business Mailing Address
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Address Line | 1973 S RANCHO MANANA CIR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-7003
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Country | US
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Telephone | 928-301-9602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 1548
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License Number State | AZ
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