Healthcare Provider Details

I. General information

NPI: 1821634049
Provider Name (Legal Business Name): ANGELA DAWN WOLFE PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MADISON SQUARE DR
MADISONVILLE KY
42431-2740
US

IV. Provider business mailing address

24 MADISON SQUARE DR
MADISONVILLE KY
42431-2740
US

V. Phone/Fax

Practice location:
  • Phone: 270-824-9227
  • Fax:
Mailing address:
  • Phone: 270-824-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001667
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: