Provider Demographics
NPI:1770001067
Name:ROCKETT, GENEVIEVE CLISSOLD (PT)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:CLISSOLD
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WIDDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6699
Mailing Address - Country:US
Mailing Address - Phone:919-387-3532
Mailing Address - Fax:
Practice Address - Street 1:100 FITNESS DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7263
Practice Address - Country:US
Practice Address - Phone:919-557-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist