Provider Demographics
NPI:1134419658
Name:WOLFE, ROGER ERIC (PT)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ERIC
Last Name:WOLFE
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 1:930 CASTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2110
Mailing Address - Country:US
Mailing Address - Phone:812-945-8333
Mailing Address - Fax:
Practice Address - Street 1:3602 NORTHGATE CT
Practice Address - Street 2:SUITE 15
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6417
Practice Address - Country:US
Practice Address - Phone:812-944-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010473A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist