Provider Demographics
NPI:1255798831
Name:WOLF, JOANNE BETH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:BETH
Last Name:WOLF
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 1:2911 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2919
Mailing Address - Country:US
Mailing Address - Phone:773-859-1834
Mailing Address - Fax:
Practice Address - Street 1:3413 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1714
Practice Address - Country:US
Practice Address - Phone:202-793-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871878225100000X
225100000X
IL070.025051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC498140YT9Medicare PIN
DCG02816Medicare PIN