Provider Demographics
NPI:1861899536
Name:US ARMY
Entity type:Organization
Organization Name:US ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:719-649-3947
Mailing Address - Street 1:8800 MAIN ST
Mailing Address - Street 2:APT 408C
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-2159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8800 MAIN ST
Practice Address - Street 2:APT 408C
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13603-2159
Practice Address - Country:US
Practice Address - Phone:719-649-3947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0012834261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy