MEDICARE: MATTHEW WOLFE 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	1305196	TX

General Provider Information

NPI Number	:	1528552114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WOLFE DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-541-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 W MCDERMOTT DR STE 108
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-6393
Country	:	US
Telephone Number	:	469-656-1343
Fax Number	:	469-656-1463

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	09/01/2023

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