Provider Demographics
NPI:1912871427
Name:WOOLFOLK, KIMBERLY DELISE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DELISE
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:SELAH
Other - Middle Name:MASSAGE
Other - Last Name:WELLNESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2123 BRAEBURN EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2582
Mailing Address - Country:US
Mailing Address - Phone:463-201-2042
Mailing Address - Fax:
Practice Address - Street 1:2123 BRAEBURN EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2582
Practice Address - Country:US
Practice Address - Phone:463-201-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist