Provider Demographics
NPI:1275902793
Name:WOLFE, CASEY A (DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:A
Last Name:WOLFE
Suffix:
Gender:M
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:PO BOX 242278
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2278
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:12050 ETRIS RD
Practice Address - Street 2:SUITE E-150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1443
Practice Address - Country:US
Practice Address - Phone:770-801-4657
Practice Address - Fax:470-545-7975
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist