Provider Demographics
NPI:1467082412
Name:ROLLF-SIMMONS, MIQUELA MERRIE (LMT)
Entity Type:Individual
Prefix:
First Name:MIQUELA
Middle Name:MERRIE
Last Name:ROLLF-SIMMONS
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 1:303 HARGROVE RD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5029
Mailing Address - Country:US
Mailing Address - Phone:205-415-2463
Mailing Address - Fax:
Practice Address - Street 1:303 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5029
Practice Address - Country:US
Practice Address - Phone:205-415-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist