Provider Demographics
NPI:1881970366
Name:ROLLER, DAVID C (ATC/L)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:ROLLER
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 LAUREL CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9207
Mailing Address - Country:US
Mailing Address - Phone:479-659-5098
Mailing Address - Fax:
Practice Address - Street 1:2300 S DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-6277
Practice Address - Country:US
Practice Address - Phone:479-636-2202
Practice Address - Fax:479-631-3554
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT1422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer