Provider Demographics
NPI:1386451763
Name:ROLLINS, THOMAS JR (LMT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ROLLINS
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 FRANKFORD AVE # A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1638
Mailing Address - Country:US
Mailing Address - Phone:267-796-3334
Mailing Address - Fax:
Practice Address - Street 1:2464 FRANKFORD AVE # A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1638
Practice Address - Country:US
Practice Address - Phone:267-796-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist