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General NPI Number Information
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NPI Number | 1336707785
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Entity Type | Individual
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Provider Name | BRANDON M WOLFF
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Gender | Male
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 1319 BEASER AVE
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City | ASHLAND
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State | WI
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Zip | 54806-3614
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Country | US
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Telephone | 715-682-3468
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Fax |
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Provider Business Mailing Address
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Address Line | 520 WILKES DR STE 17
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City | GREEN RIVER
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State | WY
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Zip | 82935-4854
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Country | US
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Telephone | 307-875-1788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14695-24
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License Number State | WI
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