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NPI Code Detail

MEDICARE: SEASON GREGIELLE WOOLDRIDGE PT

MEDICARE: SEASON GREGIELLE WOOLDRIDGE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1316857TX

General Provider Information

NPI Number : 1346659224
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEASON GREGIELLE WOOLDRIDGE PT
Provider Business Mailing Address
First Line : 2740 COLLEGE AVE
Second Line :
City : CONWAY
State : AR
Zip : 72034-6141
Country : US
Telephone Number : 501-329-5459
Fax Number :
Provider Business Practice Location Address
First Line : 6025 SPORTS VILLAGE RD
Second Line :
City : FRISCO
State : TX
Zip : 75033-3505
Country : US
Telephone Number : 214-687-9374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2014
Last Update Date : 08/20/2019

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