Provider Demographics
NPI:1669218541
Name:WOLFE, TYLER ALLEN (PT, DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALLEN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 FERRIS SQ STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3251
Mailing Address - Country:US
Mailing Address - Phone:800-683-1209
Mailing Address - Fax:
Practice Address - Street 1:60 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4162
Practice Address - Country:US
Practice Address - Phone:603-743-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4347225100000X
AK223416225100000X
NHCP041032T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist