Provider Demographics
NPI:1073500674
Name:WOODBECK, KAREN JANE (MS, PT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JANE
Last Name:WOODBECK
Suffix:
Gender:F
Credentials:MS, PT, OCS, ATC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1282 WHITE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6723
Mailing Address - Country:US
Mailing Address - Phone:408-550-6076
Mailing Address - Fax:408-608-1970
Practice Address - Street 1:1282 WHITE OAKS RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6723
Practice Address - Country:US
Practice Address - Phone:408-550-6076
Practice Address - Fax:408-608-6076
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150052251S0007X, 2251X0800X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer