Provider Demographics
NPI:1326484833
Name:ROLLER, ROBERT ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:ROLLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 DOE RUN RD.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1606
Mailing Address - Country:US
Mailing Address - Phone:850-591-6313
Mailing Address - Fax:850-877-2917
Practice Address - Street 1:3508 DOE RUN RD.
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1606
Practice Address - Country:US
Practice Address - Phone:850-591-6313
Practice Address - Fax:850-877-2917
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT115592251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology