Provider Demographics
NPI:1013547769
Name:WOODARD, DANA (ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 US HIGHWAY 17 BYPASS SOUTH
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6430
Mailing Address - Country:US
Mailing Address - Phone:843-458-5710
Mailing Address - Fax:
Practice Address - Street 1:2412 KINGS RIVER RD
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-5333
Practice Address - Country:US
Practice Address - Phone:703-999-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer