Provider Demographics
NPI:1164966867
Name:WOODWARD, KATE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WOODWARD
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 1:2650 CAMINO DEL RIO N
Mailing Address - Street 2:200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1621
Mailing Address - Country:US
Mailing Address - Phone:619-295-3000
Mailing Address - Fax:619-295-3011
Practice Address - Street 1:2650 CAMINO DEL RIO N
Practice Address - Street 2:200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1621
Practice Address - Country:US
Practice Address - Phone:619-295-3000
Practice Address - Fax:619-295-3011
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2925372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic