Healthcare Provider Details

I. General information

NPI: 1912816695
Provider Name (Legal Business Name): MATTHEW WOLF PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EILEEN WAY
SYOSSET NY
11791-5323
US

IV. Provider business mailing address

27 SABER DR
KINGS PARK NY
11754-2833
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-9797
  • Fax:
Mailing address:
  • Phone: 516-622-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056422
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: