Provider Demographics
NPI:1003296922
Name:WOLF, AMY (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1900 LONG PRAIRIE RD
Mailing Address - Street 2:104
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4217
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:8700 N TARRANT PKWY
Practice Address - Street 2:STE 113
Practice Address - City:N RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8464
Practice Address - Country:US
Practice Address - Phone:817-498-8344
Practice Address - Fax:817-498-8702
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist