Provider Demographics
NPI:1316417199
Name:ROLLMAN, ELLEN ROLLS (MMT, LMT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROLLS
Last Name:ROLLMAN
Suffix:
Gender:F
Credentials:MMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 EARLES CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2808
Mailing Address - Country:US
Mailing Address - Phone:717-479-2727
Mailing Address - Fax:
Practice Address - Street 1:5216 EARLES CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-0000
Practice Address - Country:US
Practice Address - Phone:717-479-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM09577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist