Provider Demographics
NPI:1568902187
Name:WOLFSON, NANCY (MPT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23226 ROBIN SONG DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4486
Mailing Address - Country:US
Mailing Address - Phone:301-355-4105
Mailing Address - Fax:
Practice Address - Street 1:23226 ROBIN SONG DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4486
Practice Address - Country:US
Practice Address - Phone:301-355-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist