Provider Demographics
NPI:1821227125
Name:WOLF, AMANDA ELLIOTT (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLIOTT
Last Name:WOLF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3891 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1740
Mailing Address - Country:US
Mailing Address - Phone:256-772-9243
Mailing Address - Fax:
Practice Address - Street 1:245 CAHABA VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2217
Practice Address - Country:US
Practice Address - Phone:205-942-6820
Practice Address - Fax:205-942-5884
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist