1588967434 NPI number — MARGARET LORETTA ROLLER PT, MS, DPT

Table of content: MARGARET LORETTA ROLLER PT, MS, DPT (NPI 1588967434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588967434 NPI number — MARGARET LORETTA ROLLER PT, MS, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLER
Provider First Name:
MARGARET
Provider Middle Name:
LORETTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, MS, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLER
Provider Other First Name:
PEGGY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588967434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CSUN DEPARTMENT OF PHYSICAL THERAPY
Provider Second Line Business Mailing Address:
18111 NORDHOFF ST.
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91330-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-677-4684
Provider Business Mailing Address Fax Number:
818-677-7411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CSUN DEPARTMENT OF PHYSICAL THERAPY
Provider Second Line Business Practice Location Address:
18111 NORDHOFF ST.
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91330-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-677-4684
Provider Business Practice Location Address Fax Number:
818-677-7411
Provider Enumeration Date:
12/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251N0400X , with the licence number:  16008 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)