Provider Demographics
NPI:1265842645
Name:WOLFF, RYAN (MS ATC/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MS ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17651 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6585
Mailing Address - Country:US
Mailing Address - Phone:602-548-3047
Mailing Address - Fax:
Practice Address - Street 1:1750 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6307
Practice Address - Country:US
Practice Address - Phone:623-915-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer