Provider Demographics
NPI:1225399181
Name:WOLFE, EVERETT JOHN (RMT)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:JOHN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5000
Mailing Address - Country:US
Mailing Address - Phone:303-777-1151
Mailing Address - Fax:
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5000
Practice Address - Country:US
Practice Address - Phone:303-777-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CO1469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1469OtherMASSAGE THERAPIST