Individual
COLLEEN DE WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9001 BROADWAY, MERRILLVILLE, IN 46410-7041
(219) 776-4023
Mailing address
9001 BROADWAY, MERRILLVILLE, IN 46410-7041
(219) 776-4023
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06001466A
IN
2255A2300X
Athletic Trainer
06001466A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06001466A
LICENSE
IN
Enumeration date
12/26/2025
Last updated
07/24/2026
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