Individual
MOLLY WIETFELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4111 PARK PLACE DR, FORT WAYNE, IN 46845-6002
(260) 373-2111
Mailing address
4111 PARK PLACE DR, FORT WAYNE, IN 46845-6002
(260) 373-2111
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002681A
IN
Other
Enumeration date
10/09/2012
Last updated
10/09/2012
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