Provider Demographics
NPI:1437550969
Name:WOOLEY, REUBEN LIKA
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:LIKA
Last Name:WOOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4776 N FIVE MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2715
Mailing Address - Country:US
Mailing Address - Phone:208-658-9500
Mailing Address - Fax:208-658-9501
Practice Address - Street 1:4776 N FIVE MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2715
Practice Address - Country:US
Practice Address - Phone:208-658-9500
Practice Address - Fax:208-658-9501
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37496225100000X
IDPT-7140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist