Healthcare Provider Details

I. General information

NPI: 1619415643
Provider Name (Legal Business Name): BENJAMIN WOOMER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 CARAWAY LN
CEDAR FALLS IA
50613-8172
US

IV. Provider business mailing address

5515 PLATT RD
CEDAR FALLS IA
50613-9611
US

V. Phone/Fax

Practice location:
  • Phone: 843-388-7667
  • Fax:
Mailing address:
  • Phone: 803-360-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number135820
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: