Provider Demographics
NPI:1568637130
Name:WOLFE, MICHELLE ANN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:HOERNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1810 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2992
Mailing Address - Country:US
Mailing Address - Phone:405-624-6592
Mailing Address - Fax:
Practice Address - Street 1:1810 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2992
Practice Address - Country:US
Practice Address - Phone:405-624-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4053225100000X
WI5828-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist