Provider Demographics
NPI:1689686354
Name:WOLFE, MATTHEW H (ATC, NREMT-B)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:H
Last Name:WOLFE
Suffix:
Gender:M
Credentials:ATC, NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:RANDALL
Mailing Address - State:IA
Mailing Address - Zip Code:50231-0005
Mailing Address - Country:US
Mailing Address - Phone:407-506-4971
Mailing Address - Fax:
Practice Address - Street 1:640 MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDALL
Practice Address - State:IA
Practice Address - Zip Code:50231-7708
Practice Address - Country:US
Practice Address - Phone:407-506-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL18912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer