Provider Demographics
NPI:1689862583
Name:WOLFF, LEON DAVID (PT, CHT)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:DAVID
Last Name:WOLFF
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HANSHAW RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1530
Mailing Address - Country:US
Mailing Address - Phone:607-229-2165
Mailing Address - Fax:607-793-9497
Practice Address - Street 1:903 HANSHAW RD STE 5
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1530
Practice Address - Country:US
Practice Address - Phone:607-229-2165
Practice Address - Fax:607-793-9497
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist