Provider Demographics
NPI:1154512960
Name:WOOD, SANDRA EVELYN (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:EVELYN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N KALAHEO AVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2319
Mailing Address - Country:US
Mailing Address - Phone:808-233-5495
Mailing Address - Fax:808-233-5494
Practice Address - Street 1:45-691 KEAAHALA RD
Practice Address - Street 2:ROOM 3
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-5495
Practice Address - Fax:808-233-5494
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics