Provider Demographics
NPI:1619349743
Name:SENTRY SAFETY AND PHYSICAL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SENTRY SAFETY AND PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:SENTRY SAFETY AND PT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:WOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:970-988-2214
Mailing Address - Street 1:4504 VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-9159
Mailing Address - Country:US
Mailing Address - Phone:970-988-2214
Mailing Address - Fax:
Practice Address - Street 1:4504 VERDE DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-9159
Practice Address - Country:US
Practice Address - Phone:970-988-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty