MEDICARE: DR. KEVIN RICHARD WOLAK PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	39680	FL

General Provider Information

NPI Number	:	1326752635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN RICHARD WOLAK PT, DPT

Provider Business Mailing Address
First Line	:	9083 CAVATINA PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 AVENUE OF THE CHAMPIONS STE 100
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3615
Country	:	US
Telephone Number	:	561-223-3872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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