Healthcare Provider Details

I. General information

NPI: 1023398039
Provider Name (Legal Business Name): HEATHER WULFF D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 ARBOR ST
OMAHA NE
68144-2981
US

IV. Provider business mailing address

18776 W 880 RD
PARK HILL OK
74451-2037
US

V. Phone/Fax

Practice location:
  • Phone: 866-334-1919
  • Fax: 402-334-6084
Mailing address:
  • Phone: 918-931-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1209781
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4426
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: