Provider Demographics
NPI:1194847574
Name:DUTCHER-WOLF, DARRELYN KAY (PT)
Entity Type:Individual
Prefix:
First Name:DARRELYN
Middle Name:KAY
Last Name:DUTCHER-WOLF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 GENEIVE ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7817
Mailing Address - Country:US
Mailing Address - Phone:805-479-3357
Mailing Address - Fax:805-987-3636
Practice Address - Street 1:450 ROSEWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-389-4781
Practice Address - Fax:805-389-4725
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist