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General NPI Number Information
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NPI Number | 1538270137
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Entity Type | Organization
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Legal Business Name | DIANE J. WOOLDRIDGE, PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 3507 POST ST
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City | CLINTON
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State | NY
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Zip | 13323-4716
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Country | US
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Telephone | 315-853-1401
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Fax | 315-853-7629
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Provider Business Mailing Address
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Address Line | 3507 POST ST
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City | CLINTON
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State | NY
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Zip | 13323-4716
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Country | US
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Telephone | 315-853-1401
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Fax | 315-853-7629
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Authorized Official
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Title or Position | PT/SOLE PROPRIETOR
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Name | DIANE J WOOLDRIDGE
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Credential | PT
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Telephone | 315-853-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 009744-1
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License Number State | NY
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