Basic Information
| Provider Information | |||||||||
| NPI: | 1881057289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROLING | ||||||||
| FirstName: | KORTNEY | ||||||||
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| Credential: | P.T.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2515 JOLLY LN | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577036129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053898916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 949 HARMON ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577852452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057202400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0348 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.