Provider Demographics
NPI:1285854323
Name:WOLFE, ELIZABETH A (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:WOLFE
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 1:122 S MICHIGAN AVE STE 1441
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6173
Mailing Address - Country:US
Mailing Address - Phone:312-986-9833
Mailing Address - Fax:312-962-8855
Practice Address - Street 1:122 S MICHIGAN AVE STE 1441
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6173
Practice Address - Country:US
Practice Address - Phone:312-986-9833
Practice Address - Fax:312-962-8855
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005742225100000X
IL070018911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist