Provider Demographics
NPI:1033653373
Name:WOOSLEY MEDICAL REHAB AND WELLNESS
Entity Type:Organization
Organization Name:WOOSLEY MEDICAL REHAB AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WOOSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:APN
Authorized Official - Phone:615-859-6644
Mailing Address - Street 1:913 CONFERENCE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1991
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:
Practice Address - Street 1:913 CONFERENCE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN189752081P2900X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010073Medicaid
TNQ010073Medicaid