Provider Demographics
NPI:1972110492
Name:WOLF, AMELIA RAE (DPT)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:RAE
Last Name:WOLF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:W229N1416 WESTWOOD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1309
Mailing Address - Country:US
Mailing Address - Phone:262-349-9297
Mailing Address - Fax:262-278-4062
Practice Address - Street 1:W229N1416 WESTWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1309
Practice Address - Country:US
Practice Address - Phone:262-349-9297
Practice Address - Fax:262-278-4062
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14666-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist