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General NPI Number Information
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NPI Number | 1316417199
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Entity Type | Individual
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Provider Name | ELLEN ROLLS ROLLMAN MMT, LMT
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Gender | Female
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 5216 EARLES CT
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City | FREDERICK
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State | MD
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Zip | 21703-0000
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Country | US
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Telephone | 717-479-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 5216 EARLES CT
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City | FREDERICK
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State | MD
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Zip | 21703-2808
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Country | US
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Telephone | 717-479-2727
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M09577
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License Number State | MD
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