Provider Demographics
NPI:1043494610
Name:ROLLS, SCOTT J (PTA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:J
Last Name:ROLLS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-462-5802
Mailing Address - Fax:
Practice Address - Street 1:414 N WILSON ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930
Practice Address - Country:US
Practice Address - Phone:402-756-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE453225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant