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NPI Code Detail

MEDICARE: SCOTT M WOLFF LPT

MEDICARE: SCOTT M WOLFF LPT
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
1225100000XPhysical TherapistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1354882603001OTHERILIDPA PROVIDER #

General Provider Information

NPI Number : 1578637401
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT M WOLFF LPT
Provider Business Mailing Address
First Line : 100 E IRVING PARK RD
Second Line : STE. #107
City : ROSELLE
State : IL
Zip : 60172-2048
Country : US
Telephone Number : 630-439-0009
Fax Number : 630-439-0011
Provider Business Practice Location Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number : 773-374-5860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 03/11/2008

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