MEDICARE: JENNIFER WOLFFIS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501007449	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225100000X	OTHER	MI	TAXONOMY CODE
2	5501007449	OTHER	MI	PHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1104006626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WOLFFIS PT

Provider Business Mailing Address
First Line	:	1232 GRISWOLD ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3815
Country	:	US
Telephone Number	:	616-207-3861
Fax Number	:	616-327-6364

Provider Business Practice Location Address
First Line	:	1232 GRISWOLD ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3815
Country	:	US
Telephone Number	:	616-207-3861
Fax Number	:	616-327-6364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	04/29/2024

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