Provider Demographics
NPI:1013039015
Name:ROLING, PEGGY JO (PT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:ROLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 LAWTHER ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8136
Mailing Address - Country:US
Mailing Address - Phone:563-582-0901
Mailing Address - Fax:
Practice Address - Street 1:301 NE TRILEIN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2170
Practice Address - Country:US
Practice Address - Phone:515-965-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02769225100000X
WI6278-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist