Provider Demographics
NPI:1770902769
Name:WOLF, SEBASTIAN (DPT)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13238 SW 29TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-9017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8585 SW HIGHWAY 200
Practice Address - Street 2:UNIT 8
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9644
Practice Address - Country:US
Practice Address - Phone:352-693-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist