Provider Demographics
NPI:1740606722
Name:WOLFRAM, SALENA CRYSTAL (DPT)
Entity Type:Individual
Prefix:DR
First Name:SALENA
Middle Name:CRYSTAL
Last Name:WOLFRAM
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 1:147 SEVILLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1117
Mailing Address - Country:US
Mailing Address - Phone:559-318-6883
Mailing Address - Fax:
Practice Address - Street 1:147 SEVILLA AVE
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1117
Practice Address - Country:US
Practice Address - Phone:559-318-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41154225100000X
FLPT35127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist