Provider Demographics
NPI:1144636945
Name:ROLLINS, STACY (LMT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ROLLINS
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 1:853 E BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04901-2839
Mailing Address - Country:US
Mailing Address - Phone:207-861-2515
Mailing Address - Fax:
Practice Address - Street 1:853 E BENTON RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-2839
Practice Address - Country:US
Practice Address - Phone:207-861-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4433225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist