Provider Demographics
NPI:1639402977
Name:DEWOLFE, TARA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:DEWOLFE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7709
Mailing Address - Country:US
Mailing Address - Phone:563-421-3497
Mailing Address - Fax:563-421-3699
Practice Address - Street 1:2535 MAPLECREST RD STE 23
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2716
Practice Address - Country:US
Practice Address - Phone:563-421-3497
Practice Address - Fax:563-421-3699
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA038882251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics