Provider Demographics
NPI:1649221300
Name:WOLFE, LINDA L (RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1685
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:775-885-2528
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1685
Practice Address - Country:US
Practice Address - Phone:775-883-4161
Practice Address - Fax:775-883-2528
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416029Medicaid
NV37124Medicare ID - Type UnspecifiedMEDOCARE PROVIDER NUMBER