Provider Demographics
NPI:1538230537
Name:ROLAND, RUTH (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ROLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 FORT SALONGA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3044
Mailing Address - Country:US
Mailing Address - Phone:631-261-0444
Mailing Address - Fax:631-261-3112
Practice Address - Street 1:389 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3044
Practice Address - Country:US
Practice Address - Phone:631-261-0444
Practice Address - Fax:631-261-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ42061Medicare ID - Type Unspecified