Provider Demographics
NPI:1669807517
Name:BEHLIN ROLLOCK, TERRINICOLE (LMT)
Entity type:Individual
Prefix:MS
First Name:TERRINICOLE
Middle Name:
Last Name:BEHLIN ROLLOCK
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 1:10014 TWO NOTCH RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4317
Mailing Address - Country:US
Mailing Address - Phone:803-312-2861
Mailing Address - Fax:
Practice Address - Street 1:10014 TWO NOTCH RD
Practice Address - Street 2:SUITE K
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4317
Practice Address - Country:US
Practice Address - Phone:803-312-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist