Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1722 | OR |
N | 225100000X | Physical Therapist | 21668 | CA |
N | 225100000X | Physical Therapist | 3434 | WI |
NPI | 1003000464 |
---|---|
Provider Name | Laurel Wolf |
First Address | Klamath Falls, OR 97603-5361 |
Second Address | Klamath Falls, OR 97603-5361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 29/08/2007 |