Provider Demographics
NPI:1922413079
Name:WOOLSEY, MATTHEW (LAC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WOOLSEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W CONTINENTAL RD STE 132
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85622-3546
Mailing Address - Country:US
Mailing Address - Phone:801-971-1340
Mailing Address - Fax:
Practice Address - Street 1:210 W CONTINENTAL RD STE 132
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3546
Practice Address - Country:US
Practice Address - Phone:801-971-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist