Provider Demographics
NPI:1578044319
Name:MOSENTSEVA-ROLLINS, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOSENTSEVA-ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 PRESTON RD APT 102
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3571
Mailing Address - Country:US
Mailing Address - Phone:214-263-4486
Mailing Address - Fax:
Practice Address - Street 1:700 E VISTA RIDGE MALL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8339
Practice Address - Country:US
Practice Address - Phone:972-906-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2062441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant