Provider Demographics
NPI:1689947533
Name:WOLFE, KRISTINA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1151 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9646
Mailing Address - Country:US
Mailing Address - Phone:919-556-1336
Mailing Address - Fax:919-556-3118
Practice Address - Street 1:10000 CAMBRIDGE VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7707
Practice Address - Country:US
Practice Address - Phone:919-350-1508
Practice Address - Fax:919-350-1475
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC10409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist