Provider Demographics
NPI:1811963135
Name:WOLFE, BONNIE L (MS, PT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6008
Mailing Address - Country:US
Mailing Address - Phone:401-228-3939
Mailing Address - Fax:401-383-4372
Practice Address - Street 1:1193 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6008
Practice Address - Country:US
Practice Address - Phone:401-228-3939
Practice Address - Fax:401-383-3943
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI403427OtherBLUECHIP
007006616Medicare ID - Type Unspecified