Provider Demographics
NPI:1073746145
Name:WOOD, GAYLA E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:E
Last Name:WOOD
Suffix:
Gender:F
Credentials:PTA
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 381
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-0381
Mailing Address - Country:US
Mailing Address - Phone:660-385-6540
Mailing Address - Fax:660-385-6542
Practice Address - Street 1:2005 N MISSOURI ST
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2164
Practice Address - Country:US
Practice Address - Phone:660-385-6540
Practice Address - Fax:660-385-6542
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001009510225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant