Provider Demographics
NPI:1336694025
Name:WOLFE, TRISTY (ATC)
Entity Type:Individual
Prefix:
First Name:TRISTY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 CARRABASSETT DR
Mailing Address - Street 2:
Mailing Address - City:CARRABASSETT VALLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04947-5705
Mailing Address - Country:US
Mailing Address - Phone:207-237-4494
Mailing Address - Fax:207-237-4041
Practice Address - Street 1:3197 CARRABASSETT DR
Practice Address - Street 2:
Practice Address - City:CARRABASSETT VALLEY
Practice Address - State:ME
Practice Address - Zip Code:04947-5705
Practice Address - Country:US
Practice Address - Phone:207-237-4494
Practice Address - Fax:207-237-4041
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT5242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer