Provider Demographics
NPI:1467483651
Name:WOOLF, JOHN M (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:WOOLF
Suffix:
Gender:M
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:PO BOX 43085
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3085
Mailing Address - Country:US
Mailing Address - Phone:520-321-0204
Mailing Address - Fax:520-321-0495
Practice Address - Street 1:3945 E PARADISE FALLS DR
Practice Address - Street 2:#109
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6683
Practice Address - Country:US
Practice Address - Phone:520-321-0204
Practice Address - Fax:520-321-0495
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825119Medicaid
AZZ68495Medicare PIN