Provider Demographics
NPI:1962250902
Name:ROLLINS, LEWIS T JR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:T
Last Name:ROLLINS
Suffix:JR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 S 2835 E
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2076
Mailing Address - Country:US
Mailing Address - Phone:801-949-7213
Mailing Address - Fax:
Practice Address - Street 1:3998 S 2835 E
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-2076
Practice Address - Country:US
Practice Address - Phone:801-949-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12976489-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist