Provider Demographics
NPI:1164123329
Name:WOOD, JENNIFER (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
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 1:445 MIDDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-3119
Mailing Address - Country:US
Mailing Address - Phone:804-916-0927
Mailing Address - Fax:
Practice Address - Street 1:4325 BRAMBLETON AVE STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3404
Practice Address - Country:US
Practice Address - Phone:540-772-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist