Provider Demographics
NPI:1952744385
Name:WOLCOTT, LOIS E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:E
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 139
Mailing Address - Street 2:19 SOUTH ACADEMY STREET
Mailing Address - City:WYOMING
Mailing Address - State:NY
Mailing Address - Zip Code:14591-0139
Mailing Address - Country:US
Mailing Address - Phone:585-495-6722
Mailing Address - Fax:
Practice Address - Street 1:19 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:NY
Practice Address - Zip Code:14591-0139
Practice Address - Country:US
Practice Address - Phone:585-495-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007191-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant