Provider Demographics
NPI:1063508885
Name:WOODFIELD, BRYCE S (PT)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:S
Last Name:WOODFIELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84028-0276
Mailing Address - Country:US
Mailing Address - Phone:435-946-2777
Mailing Address - Fax:435-946-9777
Practice Address - Street 1:95 WEST 50 SOUTH
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:UT
Practice Address - Zip Code:84028
Practice Address - Country:US
Practice Address - Phone:435-946-2777
Practice Address - Fax:435-946-9777
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62365152401225100000X
IDPT2075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist