MEDICARE: MS. SHAQUITA ROLAND PTA

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	225200000X	Physical Therapy Assistant	6884	MS

General Provider Information

NPI Number	:	1891368866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAQUITA ROLAND PTA

Provider Business Mailing Address
First Line	:	755 MEDICAL CENTER DRIVE
Second Line	:	SUITE 2307
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-0003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 MEDICAL CENTER DRIVE
Second Line	:	SUITE 2307
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-0003
Country	:	US
Telephone Number	:	409-795-1591
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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