Provider Demographics
NPI:1205139573
Name:WOLF, DONNA RENE (LMT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RENE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17858 160TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1908
Mailing Address - Country:US
Mailing Address - Phone:425-239-9248
Mailing Address - Fax:
Practice Address - Street 1:17858 160TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1908
Practice Address - Country:US
Practice Address - Phone:425-239-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist