Basic Information
| Provider Information | |||||||||
| NPI: | 1275507469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1238 BEECHWOOD RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432272011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142372854 | ||||||||
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| Practice Location | |||||||||
| Address1: | 584 COUNTY LINE ROAD WEST | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143556000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT-002371 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.