MEDICARE: ALLISON WOLFE ATC

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	2024023964	MO

General Provider Information

NPI Number	:	1366229502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON WOLFE ATC

Provider Business Mailing Address
First Line	:	1800 STONEY PKWY APT 208
Second Line	:
City	:	BARNHART
State	:	MO
Zip	:	63012-1280
Country	:	US
Telephone Number	:	314-277-9756
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S NEW BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8702
Country	:	US
Telephone Number	:	314-251-6000
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	08/06/2025

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