Provider Demographics
NPI:1982833109
Name:ROLLENHAGEN, MELISSA MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MICHELLE
Last Name:ROLLENHAGEN
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 1:3525 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3101
Mailing Address - Country:US
Mailing Address - Phone:805-641-6415
Mailing Address - Fax:805-641-6424
Practice Address - Street 1:3525 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3101
Practice Address - Country:US
Practice Address - Phone:805-641-6415
Practice Address - Fax:805-641-6424
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206017225100000X
CA36667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist