MEDICARE: MRS. CHANTEL LYNN WOLFE MPT

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	4002	OK

General Provider Information

NPI Number	:	1942409230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANTEL LYNN WOLFE MPT

Provider Business Mailing Address
First Line	:	8011 S SHERIDAN RD UNIT B
Second Line	:	SQUARE ONE SHOPPING CENTER
City	:	TULSA
State	:	OK
Zip	:	74133-8950
Country	:	US
Telephone Number	:	918-481-3390
Fax Number	:	918-481-3510

Provider Business Practice Location Address
First Line	:	8011 S SHERIDAN RD UNIT B
Second Line	:	SQUARE ONE SHOPPING CENTER
City	:	TULSA
State	:	OK
Zip	:	74133-8950
Country	:	US
Telephone Number	:	918-481-3390
Fax Number	:	918-481-3510

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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