MEDICARE: MR. ROBERT GEORGE WOLFE III PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	017764	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	AA1220	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000920156002	OTHER	NY	HEALTHNOW NY
2	5056028	OTHER	NY	AETNA
3	000021089	OTHER	NY	BSCNY
5	161303109	OTHER	NY	CIGNA
6	161303109	OTHER	NY	UNITED HEALTHCARE
7	435004	OTHER	NY	MVP

General Provider Information

NPI Number	:	1760421325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT GEORGE WOLFE III PT

Provider Business Mailing Address
First Line	:	510 TOWNE DR
Second Line	:	SUITE 100
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1331
Country	:	US
Telephone Number	:	315-637-4747
Fax Number	:	315-637-6711

Provider Business Practice Location Address
First Line	:	510 TOWNE DR
Second Line	:	SUITE 100
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1331
Country	:	US
Telephone Number	:	315-637-4747
Fax Number	:	315-637-6711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/29/2010

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Directions to “ MR. ROBERT GEORGE WOLFE III PT” Practice Location

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