Basic Information
| Provider Information | |||||||||
| NPI: | 1043494610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLLS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024625802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 414 N WILSON ST | ||||||||
| Address2: | |||||||||
| City: | BLUE HILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027562080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2007 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 453 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.