Provider Demographics
NPI:1407447394
Name:WOLK, JAMES MAXWELL (DPT, PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MAXWELL
Last Name:WOLK
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 E SHORE CV
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6888
Mailing Address - Country:US
Mailing Address - Phone:208-819-3012
Mailing Address - Fax:
Practice Address - Street 1:5011 E SHORE CV
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6888
Practice Address - Country:US
Practice Address - Phone:208-819-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist