Provider Demographics
NPI:1245266717
Name:WOLF, JODI ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ELIZABETH
Last Name:WOLF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ELIZABETH
Other - Last Name:ROMSAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1936 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1914
Mailing Address - Country:US
Mailing Address - Phone:701-258-0029
Mailing Address - Fax:701-258-0826
Practice Address - Street 1:1936 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1914
Practice Address - Country:US
Practice Address - Phone:701-258-0029
Practice Address - Fax:701-258-0826
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6044727700Medicaid
MN650001218Medicare ID - Type Unspecified