Provider Demographics
NPI:1427207711
Name:ROHLF, CORY WADE (PT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:WADE
Last Name:ROHLF
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 1:1019 FRIENDSHIP LN APT 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5620
Mailing Address - Country:US
Mailing Address - Phone:830-329-2819
Mailing Address - Fax:
Practice Address - Street 1:1019 FRIENDSHIP LN APT 205
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5620
Practice Address - Country:US
Practice Address - Phone:830-329-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist