Provider Demographics
NPI:1063911527
Name:WOLFE, TREVOR (DPT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MI
Mailing Address - Zip Code:49894-5101
Mailing Address - Country:US
Mailing Address - Phone:906-285-2785
Mailing Address - Fax:
Practice Address - Street 1:1010 E WAUSAU AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3101
Practice Address - Country:US
Practice Address - Phone:906-285-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14092-24Medicaid