Provider Demographics
NPI:1003079609
Name:ROLLWITZ, LORI G (PA-C, MPAS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:G
Last Name:ROLLWITZ
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34910 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9229
Mailing Address - Country:US
Mailing Address - Phone:830-816-3838
Mailing Address - Fax:830-816-3833
Practice Address - Street 1:34910 INTERSTATE 10 W
Practice Address - Street 2:SUITE 301
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9229
Practice Address - Country:US
Practice Address - Phone:830-816-3838
Practice Address - Fax:830-816-3833
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant