Provider Demographics
NPI:1093013450
Name:WOOD, MARCY LYN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:LYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 LIPSCOMB ST NE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2986
Mailing Address - Country:US
Mailing Address - Phone:321-750-6606
Mailing Address - Fax:
Practice Address - Street 1:4640 LIPSCOMB ST NE
Practice Address - Street 2:SUITE 13
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2986
Practice Address - Country:US
Practice Address - Phone:321-750-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist