Provider Demographics
NPI:1437741337
Name:WOLFE, NIKOLE
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HOLLENBECK LN
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-2317
Mailing Address - Country:US
Mailing Address - Phone:406-846-1991
Mailing Address - Fax:
Practice Address - Street 1:1100 HOLLENBECK LN
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-2317
Practice Address - Country:US
Practice Address - Phone:406-846-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist