Provider Demographics
NPI:1255005781
Name:WOLFE, KYLE MARK (DPT, PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MARK
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 COPPER RIDGE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5563
Mailing Address - Country:US
Mailing Address - Phone:919-418-6399
Mailing Address - Fax:
Practice Address - Street 1:501 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3888
Practice Address - Country:US
Practice Address - Phone:800-235-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist