Healthcare Provider Details

I. General information

NPI: 1841464229
Provider Name (Legal Business Name): REBECCA ANNE WOLFE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 W I-20 #204
ARLINGTON TX
76017-1677
US

IV. Provider business mailing address

2310 W I-20 #204
ARLINGTON TX
76017-1677
US

V. Phone/Fax

Practice location:
  • Phone: 817-466-7276
  • Fax: 817-466-7286
Mailing address:
  • Phone: 817-466-7276
  • Fax: 817-466-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2070263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: