Provider Demographics
NPI:1124406863
Name:WOLFINGER, ALEXYS
Entity Type:Individual
Prefix:
First Name:ALEXYS
Middle Name:
Last Name:WOLFINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W. CHICAGO ST. APT. 20
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MH
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-279-8423
Mailing Address - Fax:
Practice Address - Street 1:528 W. CHICAGO ST. APT. 20
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-279-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
96275488Medicare PIN