Provider Demographics
NPI:1508197807
Name:WOLFE, CASSIDY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LYNN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2838
Mailing Address - Country:US
Mailing Address - Phone:319-545-4104
Mailing Address - Fax:
Practice Address - Street 1:2431 CORAL CT
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2838
Practice Address - Country:US
Practice Address - Phone:319-545-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist