Provider Demographics
NPI:1467867978
Name:VAULX-WOODY, JACQUELINE (PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VAULX-WOODY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 TAMMBELL ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-1615
Mailing Address - Country:US
Mailing Address - Phone:731-772-7986
Mailing Address - Fax:731-772-9395
Practice Address - Street 1:1151 TAMMBELL ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-1615
Practice Address - Country:US
Practice Address - Phone:731-772-7986
Practice Address - Fax:731-772-9395
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN745225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant