Provider Demographics
NPI:1447592613
Name:WOLFE, JANICE MYRA (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MYRA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 OLD BRIDGE RD # 102
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2708
Mailing Address - Country:US
Mailing Address - Phone:571-723-8311
Mailing Address - Fax:
Practice Address - Street 1:1372 OLD BRIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2708
Practice Address - Country:US
Practice Address - Phone:571-723-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist