Provider Demographics
NPI:1316710312
Name:WOLTER, RAQUEL ALBERTHA
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ALBERTHA
Last Name:WOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8661
Mailing Address - Country:US
Mailing Address - Phone:563-856-8462
Mailing Address - Fax:
Practice Address - Street 1:105 MCCARREN DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1835
Practice Address - Country:US
Practice Address - Phone:563-845-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist