Provider Demographics
NPI:1609632363
Name:ROLFES, RYAN RAYMOND
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RAYMOND
Last Name:ROLFES
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 1:2835 W. ST. GERMAIN ST.
Mailing Address - Street 2:#300
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-7729
Mailing Address - Country:US
Mailing Address - Phone:320-259-4151
Mailing Address - Fax:320-259-5707
Practice Address - Street 1:2835 W. ST. GERMAIN ST.
Practice Address - Street 2:#300
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-7729
Practice Address - Country:US
Practice Address - Phone:320-259-4151
Practice Address - Fax:320-259-5707
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant