Provider Demographics
NPI:1891724928
Name:VOLSTAD, ROBERT A (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:VOLSTAD
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 1:200 HORIZON DR STE 115
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4947
Mailing Address - Country:US
Mailing Address - Phone:919-875-1932
Mailing Address - Fax:919-875-1933
Practice Address - Street 1:200 HORIZON DR STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4947
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89832251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506661Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
1891724928Medicare PIN