Provider Demographics
NPI:1467684613
Name:WOLFF, MARIA JOY (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOY
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JOY L
Other - Last Name:FUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3179
Mailing Address - Country:US
Mailing Address - Phone:815-344-4499
Mailing Address - Fax:815-344-4779
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-344-4499
Practice Address - Fax:815-344-4779
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-00673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-00673OtherSTATE LICENSE
IL$$$$$$$$$001 1Medicaid
IL$$$$$$$$$001 1Medicaid