Provider Demographics
NPI:1649221300
Name:WOLFE, LINDA L (RPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:
Credentials:RPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 E PRATER WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8973
Mailing Address - Country:US
Mailing Address - Phone:775-746-9222
Mailing Address - Fax:775-746-9224
Practice Address - Street 1:1610 ROBB DR STE D5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3520
Practice Address - Country:US
Practice Address - Phone:775-746-9222
Practice Address - Fax:775-746-9224
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416029Medicaid
NV37124Medicare ID - Type UnspecifiedMEDOCARE PROVIDER NUMBER