Provider Demographics
NPI:1942409230
Name:WOLFE, CHANTEL LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:LYNN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8011 S SHERIDAN RD UNIT B
Mailing Address - Street 2:SQUARE ONE SHOPPING CENTER
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8950
Mailing Address - Country:US
Mailing Address - Phone:918-481-3390
Mailing Address - Fax:918-481-3510
Practice Address - Street 1:8011 S SHERIDAN RD UNIT B
Practice Address - Street 2:SQUARE ONE SHOPPING CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8950
Practice Address - Country:US
Practice Address - Phone:918-481-3390
Practice Address - Fax:918-481-3510
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-6585Medicare PIN