Individual
MR. SHANE N ROLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P. T.
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 251-6103
(318) 251-6141
Mailing address
PO BOX 1594, RUSTON, LA 71273-1594
(318) 251-6103
(318) 251-6141
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06686
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006858
—
LA
01
—
1599085
LA PROVIDER #
LA
Enumeration date
08/18/2006
Last updated
07/08/2007
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