Individual
MR. BRAD SCOTT WOLTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
070007821
IL
225100000X
Physical Therapist
Primary
070.007821
IL
Other
Enumeration date
04/11/2007
Last updated
08/28/2020
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