Provider Demographics
NPI:1568564623
Name:ROLFE, PHILLIP D (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:D
Last Name:ROLFE
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 1:5709 GENESEE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1219
Mailing Address - Country:US
Mailing Address - Phone:919-471-5137
Mailing Address - Fax:
Practice Address - Street 1:5623 DURALEIGH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2700
Practice Address - Country:US
Practice Address - Phone:919-389-7935
Practice Address - Fax:919-786-0008
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342111Medicare ID - Type UnspecifiedPROVIDER NUMBER