Provider Demographics
NPI:1619011368
Name:WOLCOTT, CHRISTINE (COMPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:COMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 N 1ST ST STE J
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2176
Mailing Address - Country:US
Mailing Address - Phone:970-265-0868
Mailing Address - Fax:
Practice Address - Street 1:1119 N 1ST ST STE J
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2176
Practice Address - Country:US
Practice Address - Phone:970-265-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1619011368Medicare PIN