Provider Demographics
NPI:1174847321
Name:ROLDAN, SANDRA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:HALLANDALE BEACH , FL 33009
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5444
Mailing Address - Country:US
Mailing Address - Phone:954-454-4280
Mailing Address - Fax:954-922-3841
Practice Address - Street 1:1801 S OCEAN DR
Practice Address - Street 2:SUITE E
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4945
Practice Address - Country:US
Practice Address - Phone:954-391-7864
Practice Address - Fax:954-391-8468
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist