Provider Demographics
NPI:1760421325
Name:WOLFE, ROBERT GEORGE III (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GEORGE
Last Name:WOLFE
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 TOWNE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1331
Mailing Address - Country:US
Mailing Address - Phone:315-637-4747
Mailing Address - Fax:315-637-6711
Practice Address - Street 1:510 TOWNE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1331
Practice Address - Country:US
Practice Address - Phone:315-637-4747
Practice Address - Fax:315-637-6711
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000920156002OtherHEALTHNOW NY
NY5056028OtherAETNA
NY000021089OtherBSCNY
NYAA1220OtherMEDICARE
NY161303109OtherCIGNA
NY161303109OtherUNITED HEALTHCARE
NY435004OtherMVP
NYDD4267Medicare ID - Type UnspecifiedMEDICARE