Provider Demographics
NPI:1124194147
Name:ROLLER, LORRAINE ANDREWS (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ANDREWS
Last Name:ROLLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MARINER GREEN CT
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-2014
Mailing Address - Country:US
Mailing Address - Phone:415-924-0649
Mailing Address - Fax:
Practice Address - Street 1:7200 REDWOOD BLVD
Practice Address - Street 2:#200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3250
Practice Address - Country:US
Practice Address - Phone:415-893-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 7827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist