Provider Demographics
NPI:1861863912
Name:WOLFMEYER, DAVID LESLIE (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LESLIE
Last Name:WOLFMEYER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W SALT MINE RD
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7013
Mailing Address - Country:US
Mailing Address - Phone:928-567-5253
Mailing Address - Fax:
Practice Address - Street 1:86 W SALT MINE RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7013
Practice Address - Country:US
Practice Address - Phone:928-567-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11840A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant