Provider Demographics
NPI:1720172612
Name:WOLF, TIFFANY MARIE (PT, DPT, CLT, CERT)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PT, DPT, CLT, CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 YUKON ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2448
Mailing Address - Country:US
Mailing Address - Phone:303-223-7451
Mailing Address - Fax:720-863-2149
Practice Address - Street 1:5790 YUKON ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2448
Practice Address - Country:US
Practice Address - Phone:303-223-7451
Practice Address - Fax:720-863-2149
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720172612OtherNPI
NV100510114Medicaid