Provider Demographics
NPI:1952502627
Name:WOLF, ADAM D (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 W HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6352
Mailing Address - Country:US
Mailing Address - Phone:312-614-1349
Mailing Address - Fax:312-526-3312
Practice Address - Street 1:1659 W HUBBARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-6352
Practice Address - Country:US
Practice Address - Phone:312-614-1349
Practice Address - Fax:312-526-3312
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS OF ILLINOIS
IL1619908OtherBCBS IL GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR