Provider Demographics
NPI:1699153684
Name:WOOLEY, RYAN JEFFREY (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JEFFREY
Last Name:WOOLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WESTBANK DR
Mailing Address - Street 2:STE. 152
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6547
Mailing Address - Country:US
Mailing Address - Phone:512-703-2687
Mailing Address - Fax:
Practice Address - Street 1:4300 WESTBANK DR
Practice Address - Street 2:STE. 152
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6547
Practice Address - Country:US
Practice Address - Phone:512-703-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1258271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist