Provider Demographics
NPI:1104004423
Name:ROLLINS, TODD STEVEN (DPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEVEN
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12930 SARATOGA AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4661
Mailing Address - Country:US
Mailing Address - Phone:408-973-7700
Mailing Address - Fax:408-973-1600
Practice Address - Street 1:12930 SARATOGA AVE STE B5
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4661
Practice Address - Country:US
Practice Address - Phone:408-973-7700
Practice Address - Fax:408-973-1600
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT344030Medicare PIN