Basic Information
| Provider Information | |||||||||
| NPI: | 1730259037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 73RD AVE N | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553695458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633151296 | ||||||||
| FaxNumber: | 7633151297 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 YORK AVE S | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529240199 | ||||||||
| FaxNumber: | 9529240314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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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 | 225100000X | 2546 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.