=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548451172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOOLBRIGHT PHYSICAL THERAPY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2007
-----------------------------------------------------
Last Update Date | 05/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2015 OCEAN DR SUITE 1
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-742-3345
-----------------------------------------------------
Fax | 561-742-8933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2015 OCEAN DR SUITE 1
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-742-3345
-----------------------------------------------------
Fax | 561-742-8933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. RAY S YBANEZ
-----------------------------------------------------
Credential | D.P.T.
-----------------------------------------------------
Telephone | 561-742-3345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT6789
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------