Provider Demographics
NPI:1902871254
Name:ROLLA, CRAIG (MPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:ROLLA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 GHANER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7201
Mailing Address - Country:US
Mailing Address - Phone:814-954-7056
Mailing Address - Fax:814-954-7083
Practice Address - Street 1:1019 GHANER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7201
Practice Address - Country:US
Practice Address - Phone:814-954-7056
Practice Address - Fax:814-954-7083
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-013477-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist