Provider Demographics
NPI:1861517302
Name:WOLVER, KESLIE L
Entity type:Individual
Prefix:MS
First Name:KESLIE
Middle Name:L
Last Name:WOLVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2288
Mailing Address - Country:US
Mailing Address - Phone:515-250-3607
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:515-331-3191
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist