MEDICARE: MR. LUDO DEWOLF 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	PT6120	FL

General Provider Information

NPI Number	:	1730162462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUDO DEWOLF PT

Provider Business Mailing Address
First Line	:	PO BOX 357279
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32635-7279
Country	:	US
Telephone Number	:	352-332-3481
Fax Number	:	352-332-3213

Provider Business Practice Location Address
First Line	:	4343 W NEWBERRY RD
Second Line	:	SUITE 4
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2817
Country	:	US
Telephone Number	:	352-373-6565
Fax Number	:	352-373-6112

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/08/2008

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Directions to “ MR. LUDO DEWOLF PT” Practice Location

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