Provider Demographics
NPI:1801100086
Name:WOLF, KARLA LEE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:LEE
Last Name:WOLF
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:KARLA
Other - Middle Name:LEE
Other - Last Name:SCHORNACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:989-723-8781
Mailing Address - Fax:
Practice Address - Street 1:1697 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist