Provider Demographics
NPI:1578637401
Name:WOLFF, SCOTT M (LPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:WOLFF
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E IRVING PARK RD
Mailing Address - Street 2:STE. #107
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2048
Mailing Address - Country:US
Mailing Address - Phone:630-439-0009
Mailing Address - Fax:630-439-0011
Practice Address - Street 1:1706 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2740
Practice Address - Country:US
Practice Address - Phone:773-374-5300
Practice Address - Fax:773-374-5860
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL354882603001OtherIDPA PROVIDER #
ILK27097Medicare ID - Type UnspecifiedMCARE LOC16
ILP00450166Medicare PIN