Provider Demographics
NPI:1124569835
Name:WOODS, KEANGELA
Entity Type:Individual
Prefix:
First Name:KEANGELA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WATER ST # 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7226
Mailing Address - Country:US
Mailing Address - Phone:702-823-4300
Mailing Address - Fax:702-906-1844
Practice Address - Street 1:203 S WATER ST # 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7226
Practice Address - Country:US
Practice Address - Phone:702-823-4300
Practice Address - Fax:702-906-1844
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner