Provider Demographics
NPI:1578365045
Name:JEAN-BAPTISTE, WOLF
Entity type:Individual
Prefix:
First Name:WOLF
Middle Name:
Last Name:JEAN-BAPTISTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14007 FALLEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4765
Mailing Address - Country:US
Mailing Address - Phone:757-956-7979
Mailing Address - Fax:
Practice Address - Street 1:14007 FALLEN OAK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4765
Practice Address - Country:US
Practice Address - Phone:757-956-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019020138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist