Provider Demographics
NPI:1073541140
Name:WOOD, TODD EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EDWARD
Last Name:WOOD
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 1:22038 OLD 44 DR
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8707
Mailing Address - Country:US
Mailing Address - Phone:530-221-9952
Mailing Address - Fax:530-221-9954
Practice Address - Street 1:22038 OLD 44 DR
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-8707
Practice Address - Country:US
Practice Address - Phone:530-275-0777
Practice Address - Fax:530-275-8779
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT170890Medicare ID - Type UnspecifiedMEDICARE NUMBER