Healthcare Provider Details

I. General information

NPI: 1790221695
Provider Name (Legal Business Name): ULRICH WOHLFAHRT PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WINGFIELD HILLS RD
SPARKS NV
89436-7220
US

IV. Provider business mailing address

2350 WINGFIELD HILLS RD
SPARKS NV
89436-7220
US

V. Phone/Fax

Practice location:
  • Phone: 775-335-8292
  • Fax:
Mailing address:
  • Phone: 775-335-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0850
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: