Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | ME99545 | FL |
N | 2081S0010X | Sports Medicine | 25MA08112700 | NJ |
N | 213ES0000X | Sports Medicine | 25MA08112700 | NJ |
NPI | 1114120748 |
---|---|
Provider Name | Dr. Erin Thor Wolff |
First Address | Ponte Vedra Beach, FL 32082-4657 |
Second Address | Jacksonville, FL 32218-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2007 |
Last Update Date | 08/03/2021 |