MEDICARE: LESLIE K WOLFE DBA ATLANTA ORTHOTICS

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1720423437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE K WOLFE DBA ATLANTA ORTHOTICS

Provider Business Mailing Address
First Line	:	1144 ZIMMER DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3321
Country	:	US
Telephone Number	:	404-897-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 ZIMMER DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3321
Country	:	US
Telephone Number	:	404-897-1205
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE WOLFE
Credential	:	P.T.
Telephone Number	:	404-897-1205

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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