MEDICARE: BRUCE WOLF PHYSICAL THERAPY, P.A.

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	174400000X	Specialist	PT2246	AR

General Provider Information

NPI Number	:	1134341381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE WOLF PHYSICAL THERAPY, P.A.

Provider Business Mailing Address
First Line	:	607 NORTHTOWN
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3121
Country	:	US
Telephone Number	:	870-425-5180
Fax Number	:	870-425-5185

Provider Business Practice Location Address
First Line	:	607 NORTHTOWN
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3121
Country	:	US
Telephone Number	:	870-425-5180
Fax Number	:	870-425-5185

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. BRUCE CAR WOLF
Credential	:	M.S.P.T.
Telephone Number	:	870-425-5180

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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