Organization
INFINITY INVICTUS, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA JO WOLTHOFF M.D. (PHYSICIAN, OWNER)
(817) 846-8502
Entity
Organization
Contact information
Practice address
800 8TH AVE, SUITE 326, FT WORTH, TX 76104-2601
(972) 795-3529
Mailing address
12134 JACKSON CREEK DR, DALLAS, TX 75243-5001
(817) 846-8502
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
N8596
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992016869
NPI
TX
Enumeration date
02/29/2016
Last updated
02/29/2016
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