Provider Demographics
NPI:1417395153
Name:DE WOLF, ANNELIES (DPT, MPH)
Entity Type:Individual
Prefix:MRS
First Name:ANNELIES
Middle Name:
Last Name:DE WOLF
Suffix:
Gender:F
Credentials:DPT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NE DAVIS FARM RD
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9618
Mailing Address - Country:US
Mailing Address - Phone:360-275-3890
Mailing Address - Fax:
Practice Address - Street 1:61 NE DAVIS FARM RD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9618
Practice Address - Country:US
Practice Address - Phone:360-275-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17568225100000X
FL12673225100000X
VI162225100000X
AK1740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist