Provider Demographics
NPI:1497491880
Name:WOLFE, DANIELLE (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4967 CAMERON VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3350
Mailing Address - Country:US
Mailing Address - Phone:518-573-3508
Mailing Address - Fax:
Practice Address - Street 1:870 GOLD HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8988
Practice Address - Country:US
Practice Address - Phone:803-835-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist