Provider Demographics
NPI:1104544139
Name:WOLFRAM, EMILY WRIGHT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:WRIGHT
Last Name:WOLFRAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 IVY CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-2246
Mailing Address - Country:US
Mailing Address - Phone:585-208-1741
Mailing Address - Fax:
Practice Address - Street 1:8115 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2751
Practice Address - Country:US
Practice Address - Phone:804-655-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist