Provider Demographics
NPI:1205729464
Name:DEWOOLFSON, KINDER (PT, DPT)
Entity type:Individual
Prefix:
First Name:KINDER
Middle Name:
Last Name:DEWOOLFSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FIELDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-1114
Mailing Address - Country:US
Mailing Address - Phone:304-554-2220
Mailing Address - Fax:304-554-2220
Practice Address - Street 1:101 FIELDVIEW AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-1114
Practice Address - Country:US
Practice Address - Phone:304-554-2220
Practice Address - Fax:304-554-2220
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist