David A Wolk
Individual provider Active NPI Physical Therapist · Perry, GA
NPI 1467580118 · NPPES record last updated Sep 16, 2020
Key facts
- NPI
- 1467580118
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT22866 (FL)
- Practice address
- 1020 Keith Dr
Perry, GA 31069-2947 - Phone
- (904) 540-8301
- Fax
- (478) 987-6918
- NPI assigned
- Mar 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cornerstone Healthcare Inc.
Practice addresses (Care Compare)
1020 Keith Dr
Perry, GA 31069-2947
Phone (478) 224-2209
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110629000826 | GA | Practitioner - Physical Therapist in Private Practice | 3274662663 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Healthcare Inc. | Current |
Accepting new patients | |
| John Goetze Physical Therapy, Inc | Physical Therapist | Past |
Accepting new patients |
Locations
1020 Keith Dr
Perry, GA 31069
Phone (478) 224-2209
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT22866 | FL | Yes |
Addresses
Primary practice location
1020 Keith Dr
Perry, GA 31069-2947
Mailing address
4008 Roundtop Circlee
Perry, GA 31069-3810
Phone (478) 224-2209
Other providers in Perry, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.