Active NPI
Jack Wynn Rolfe, PT
- Physical Therapist
- St George, UT
National Provider Identifier
1558463323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1140732401
- Practice address
- 324 North 1680 East
St George, UT 84790 - Phone
- (435) 674-1269
- Fax
- (435) 674-1269
- NPI assigned
- Sep 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1140732401 | UT | Primary |
Addresses
Primary practice location
324 North 1680 East
St George, UT 84790
Mailing address
PO Box 711185
Salt Lake City, UT 84171
Phone (801) 942-2729
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D4211 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1140732401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558463323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 711185",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84171",
"telephone_number": "801-942-2729",
"fax_number": "801-942-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 NORTH 1680 EAST",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "84790",
"telephone_number": "435-674-1269",
"fax_number": "435-674-1269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLFE",
"first_name": "JACK",
"middle_name": "WYNN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "1140732401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D4211",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.