Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 9209 | MN |
NPI | 1073857249 |
---|---|
Provider Name | Ms. Christina Marie Wolf |
First Address | Plymouth, MN 55447-5269 |
Second Address | Coon Rapids, MN 55433-5645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2012 |
Last Update Date | 12/11/2012 |