Provider Demographics
NPI:1891368866
Name:ROLAND, SHAQUITA (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHAQUITA
Middle Name:
Last Name:ROLAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 2307
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 2307
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-0003
Practice Address - Country:US
Practice Address - Phone:409-795-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant