Provider Demographics
NPI:1588037196
Name:WOLF WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:WOLF WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:479-363-6422
Mailing Address - Street 1:1 PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9216
Mailing Address - Country:US
Mailing Address - Phone:479-363-6422
Mailing Address - Fax:
Practice Address - Street 1:23 PARKCLIFF DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9230
Practice Address - Country:US
Practice Address - Phone:479-363-6422
Practice Address - Fax:479-363-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2800261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation