Provider Demographics
NPI:1215120779
Name:WOLF, REBECCA ANN FUGARINO (PTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN FUGARINO
Last Name:WOLF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9650
Mailing Address - Country:US
Mailing Address - Phone:262-628-3450
Mailing Address - Fax:
Practice Address - Street 1:3126 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9650
Practice Address - Country:US
Practice Address - Phone:262-628-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40186300Medicaid