Provider Demographics
NPI:1942338553
Name:WOOLAVER, ELIZABETH (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:WOOLAVER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 TIMBER WOLF DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8303
Mailing Address - Country:US
Mailing Address - Phone:419-868-7378
Mailing Address - Fax:419-868-7390
Practice Address - Street 1:1620 TIMBER WOLF DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8303
Practice Address - Country:US
Practice Address - Phone:419-868-7378
Practice Address - Fax:419-868-7390
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3419127380A00OtherANTHEM BCBS PRACTICE #
OH1942200704OtherOWNER NPI
OH0160617164OtherHEALTH CARE PROVIDERS
OH34191273800OtherBWC #
OH373805127-002OtherMMOH #
OH373805127-00OtherPARAMOUNT WC #
OHRE9314791Medicare ID - Type UnspecifiedPTIP#TU4044481