Individual
CHARLES WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
710 FRANKLIN ST, SUITE 100, MICHIGAN CITY, IN 46360-3563
(219) 873-7037
Mailing address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
(219) 365-6560
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001149A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200128030
—
IN
Enumeration date
08/09/2006
Last updated
08/26/2008
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