Provider Demographics
NPI:1255342218
Name:ROLLAND-LOVATO, DONNA LYNN (LMT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:ROLLAND-LOVATO
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 1:5301 PURCELL DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1920
Mailing Address - Country:US
Mailing Address - Phone:505-688-8237
Mailing Address - Fax:505-881-5207
Practice Address - Street 1:201 EUBANK BLVD NE
Practice Address - Street 2:STE. A3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2759
Practice Address - Country:US
Practice Address - Phone:505-688-8237
Practice Address - Fax:505-881-5207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist