Provider Demographics
NPI:1013547223
Name:WOLLFARTH, ALMA (PTA)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:
Last Name:WOLLFARTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-3620
Mailing Address - Country:US
Mailing Address - Phone:769-777-4400
Mailing Address - Fax:769-777-4401
Practice Address - Street 1:108 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3849
Practice Address - Country:US
Practice Address - Phone:769-777-4400
Practice Address - Fax:769-777-4401
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA-6845225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant