Provider Demographics
NPI:1154320745
Name:WOLF, RODNEY D (PT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3937
Mailing Address - Country:US
Mailing Address - Phone:309-353-8514
Mailing Address - Fax:309-353-8514
Practice Address - Street 1:2220 STATE ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3937
Practice Address - Country:US
Practice Address - Phone:309-353-8514
Practice Address - Fax:309-353-8514
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist