MEDICARE: KIMBERLY DELISE WOOLFOLK MASSAGE THERAPIST

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
1	225700000X	Massage Therapist	MT20900909	IN

General Provider Information

NPI Number	:	1912871427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DELISE WOOLFOLK MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	2123 BRAEBURN EAST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2582
Country	:	US
Telephone Number	:	463-201-2042
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 BRAEBURN EAST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2582
Country	:	US
Telephone Number	:	463-201-2042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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Directions to “ KIMBERLY DELISE WOOLFOLK MASSAGE THERAPIST” Practice Location

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