Provider Demographics
NPI:1437371929
Name:ROLDAN, RHODA P (PT)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:P
Last Name:ROLDAN
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 1:122 E KINGS HWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-3424
Mailing Address - Country:US
Mailing Address - Phone:856-231-0088
Mailing Address - Fax:856-777-8278
Practice Address - Street 1:122 E KINGS HWY
Practice Address - Street 2:SUITE 502
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-3424
Practice Address - Country:US
Practice Address - Phone:856-231-0088
Practice Address - Fax:856-777-8278
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01190400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist