Provider Demographics
NPI:1154390557
Name:WOOLBRIGHT, ROY DALE (PT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:DALE
Last Name:WOOLBRIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 STATE STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-948-2947
Mailing Address - Fax:812-948-4164
Practice Address - Street 1:2125 STATE STREET
Practice Address - Street 2:STE 2
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-948-2947
Practice Address - Fax:812-948-4164
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002018A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232630Medicare ID - Type Unspecified