Provider Demographics
NPI:1053889188
Name:BRIGNOL, ROLLYNS
Entity type:Individual
Prefix:
First Name:ROLLYNS
Middle Name:
Last Name:BRIGNOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9414
Mailing Address - Country:US
Mailing Address - Phone:813-361-4688
Mailing Address - Fax:
Practice Address - Street 1:3250 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9414
Practice Address - Country:US
Practice Address - Phone:813-361-4688
Practice Address - Fax:847-730-2988
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty