Provider Demographics
NPI:1003122128
Name:ROLLINS, JENNIFER S (CPTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 N FOREST RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-4502
Mailing Address - Country:US
Mailing Address - Phone:269-365-7351
Mailing Address - Fax:
Practice Address - Street 1:7011 W CENTRAL AVE # S125
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3378
Practice Address - Country:US
Practice Address - Phone:316-946-9662
Practice Address - Fax:316-946-9745
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02137225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant