Provider Demographics
NPI:1548406820
Name:WOLF, CELESTE MENDONCA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:MENDONCA
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4415
Mailing Address - Country:US
Mailing Address - Phone:352-794-3234
Mailing Address - Fax:
Practice Address - Street 1:855 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4415
Practice Address - Country:US
Practice Address - Phone:352-794-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist