Provider Demographics
NPI:1942930888
Name:WOLFE, TONI MARIE (PT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:MARIE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-2536
Mailing Address - Country:US
Mailing Address - Phone:815-685-7033
Mailing Address - Fax:
Practice Address - Street 1:700 S HOLDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2321
Practice Address - Country:US
Practice Address - Phone:336-299-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist