Active NPI
Donald Kirk Wolf, PT
- Physical Therapist
- Eagle Point, OR
National Provider Identifier
1194876235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1003
- Practice address
- 158 Main
Eagle Point, OR 97524 - Phone
- (541) 830-0914
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1003 | OR | Primary |
Addresses
Primary practice location
158 Main
Eagle Point, OR 97524
Mailing address
PO Box 1409
Eagle Point, OR 97524-1409
Phone (541) 830-0914
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 211144 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1003 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson County Physical Therapy LLP | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Medford, OR
- NPI 1013112903
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1194876235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1409",
"city": "EAGLE POINT",
"state": "OR",
"postal_code": "975241409",
"telephone_number": "541-830-0914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 MAIN",
"city": "EAGLE POINT",
"state": "OR",
"postal_code": "97524",
"telephone_number": "541-830-0914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "DONALD",
"middle_name": "KIRK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "1003",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "211144",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle Point, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.