Provider Demographics
NPI:1467580118
Name:WOLK, DAVID A
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:WOLK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 ROUNDTOP CIRCLEE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3810
Mailing Address - Country:US
Mailing Address - Phone:478-224-2209
Mailing Address - Fax:478-987-6918
Practice Address - Street 1:1020 KEITH DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2947
Practice Address - Country:US
Practice Address - Phone:904-540-8301
Practice Address - Fax:478-987-6918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare ID - Type Unspecified