Provider Demographics
NPI:1871690586
Name:WOLHOY, MIKE ALLEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:ALLEN
Last Name:WOLHOY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2578
Mailing Address - Country:US
Mailing Address - Phone:417-328-1485
Mailing Address - Fax:417-328-1487
Practice Address - Street 1:1600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2578
Practice Address - Country:US
Practice Address - Phone:417-328-1485
Practice Address - Fax:417-328-1487
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer