Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1264139 | TX |
NPI | 1003296922 |
---|---|
Provider Name | Amy Wolf |
First Address | Flower Mound, TX 75022-4217 |
Second Address | N Richland Hills, TX 76182-8464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 09/02/2017 |