Provider Demographics
NPI:1154052421
Name:WOLTER, GABRIELLA HOPE (DPT)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:HOPE
Last Name:WOLTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-9216
Mailing Address - Country:US
Mailing Address - Phone:218-341-3041
Mailing Address - Fax:
Practice Address - Street 1:1917 ABBOTT RD STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3449
Practice Address - Country:US
Practice Address - Phone:907-279-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist