Individual
ROLAYNE G MATTSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
105723-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107008276102
IHC-SELECTHEALTH
UT
01
—
297982
DMBA
UT
01
—
47628
PEHP
UT
05
—
N0183
—
UT
Enumeration date
01/05/2007
Last updated
07/09/2007
Update your record
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