Provider Demographics
NPI:1902429020
Name:GENAY-WOLF, JOLINE ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:JOLINE
Middle Name:ELIZABETH
Last Name:GENAY-WOLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1460
Mailing Address - Country:US
Mailing Address - Phone:208-290-7009
Mailing Address - Fax:
Practice Address - Street 1:219 CEDAR ST STE B
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1460
Practice Address - Country:US
Practice Address - Phone:208-290-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist