Healthcare Provider Details

I. General information

NPI: 1326549213
Provider Name (Legal Business Name): ALLISON ELIZABETH WOLFE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 SW 5TH AVE
MERIDIAN ID
83642-2995
US

IV. Provider business mailing address

PO BOX 561
WINTHROP WA
98862-0561
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-8282
  • Fax: 888-393-3472
Mailing address:
  • Phone: 509-429-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60756592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: