Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | P160049952 | WA |
Y | 225200000X | Physical Therapy Assistant | PTA-2416 | ID |
NPI | 1023032513 |
---|---|
Provider Name | Walter Wolf |
First Address | Spokane, WA 99223-9102 |
Second Address | Post Falls, ID 83854-6045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 27/08/2014 |