Provider Demographics
NPI:1073860573
Name:WOOD, EMILY KAY (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAY
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KAY
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:2191 NW 2ND ST BLDG 4
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9106
Practice Address - Country:US
Practice Address - Phone:503-434-9594
Practice Address - Fax:503-434-9594
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06980225100000X
WAPT60288377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500726288Medicaid
WA1073860573Medicaid
OR500726288Medicaid