Healthcare Provider Details

I. General information

NPI: 1992025837
Provider Name (Legal Business Name): KRISTINA ANN WULFF DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 N MAIN ST SUITE 1
CARBONDALE PA
18407-1914
US

IV. Provider business mailing address

RR 1 BOX 140C
TOWANDA PA
18848-9787
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-0200
  • Fax: 270-282-2229
Mailing address:
  • Phone: 570-265-1111
  • Fax: 570-265-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: