Active NPI
Charles Wolf, PT
- Physical Therapist
- Michigan City, IN
National Provider Identifier
1336159474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05001149A
- Practice address
- 710 Franklin St
Suite 100
Michigan City, IN 46360-3563 - Phone
- (219) 873-7037
- NPI assigned
- Aug 9, 2006
- 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 | 05001149A | IN | Primary |
Addresses
Primary practice location
710 Franklin St
Suite 100
Michigan City, IN 46360-3563
Mailing address
8259 Wicker Ave
Saint John, IN 46373-8878
Phone (219) 365-6560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200128030 | Medicaid | IN |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regional Sport and Spine Chiropractic PC | 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.
-
- Chiropractor
- Valparaiso, IN
- NPI 1538642087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1336159474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8259 WICKER AVE",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738878",
"telephone_number": "219-365-6560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 FRANKLIN ST",
"address_2": "SUITE 100",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463603563",
"telephone_number": "219-873-7037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "CHARLES",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05001149A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200128030",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.