Provider Demographics
NPI:1992946917
Name:ROLLEY, JOANNA FAYE (LMP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:FAYE
Last Name:ROLLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 NW ANDERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9130
Mailing Address - Country:US
Mailing Address - Phone:360-692-4262
Mailing Address - Fax:360-692-4277
Practice Address - Street 1:3561 NW ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9130
Practice Address - Country:US
Practice Address - Phone:360-692-4262
Practice Address - Fax:360-692-4277
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60059802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist