Provider Demographics
NPI:1356743215
Name:ROLLER, LORY
Entity type:Individual
Prefix:MS
First Name:LORY
Middle Name:
Last Name:ROLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORAYNE
Other - Middle Name:
Other - Last Name:ROLLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7671 N PLACITA DE LOS AMIGOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-2044
Mailing Address - Country:US
Mailing Address - Phone:520-444-4428
Mailing Address - Fax:
Practice Address - Street 1:6367 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3829
Practice Address - Country:US
Practice Address - Phone:520-721-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42792251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics