Provider Demographics
NPI:1023615309
Name:WOLFF, PRESTON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:
Last Name:WOLFF
Suffix:
Gender:M
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 1:929 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7688
Mailing Address - Country:US
Mailing Address - Phone:360-560-8763
Mailing Address - Fax:
Practice Address - Street 1:1800 E 30TH ST STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9040
Practice Address - Country:US
Practice Address - Phone:505-208-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16960225100000X
NMPT-2025-0113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist