Provider Demographics
NPI:1932108602
Name:WOOLFOLK, FLORA J
Entity Type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:J
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FLORA
Other - Middle Name:FRANCES
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17203 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22942-8519
Mailing Address - Country:US
Mailing Address - Phone:540-832-0303
Mailing Address - Fax:540-832-0303
Practice Address - Street 1:17203 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:GORDONSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22942-8519
Practice Address - Country:US
Practice Address - Phone:540-832-0303
Practice Address - Fax:540-832-0303
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010065925Medicaid
VA010065925Medicaid