Provider Demographics
NPI:1013042464
Name:WOOLDRIDGE, SHEILA R (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:R
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35689 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MO
Mailing Address - Zip Code:65281-2052
Mailing Address - Country:US
Mailing Address - Phone:660-222-3353
Mailing Address - Fax:660-388-6049
Practice Address - Street 1:301 N WEBER AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:65281-1482
Practice Address - Country:US
Practice Address - Phone:660-222-3353
Practice Address - Fax:660-388-6049
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO485744411Medicaid