Provider Demographics
NPI:1265811020
Name:ROLLS, AMBER L (ATC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:ROLLS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 HAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322
Mailing Address - Country:US
Mailing Address - Phone:757-421-4295
Mailing Address - Fax:
Practice Address - Street 1:1996 HAWK BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2124
Practice Address - Country:US
Practice Address - Phone:757-421-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126002122174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator