Provider Demographics
NPI:1225004567
Name:WOOD, ALLYSON COURTNEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:COURTNEY
Last Name:WOOD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:ALLYSON
Other - Middle Name:COURTNEY
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:220 GREYSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-452-6252
Mailing Address - Fax:478-452-6255
Practice Address - Street 1:571 HAMMOCK RD NW
Practice Address - Street 2:SUITE 106
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7184
Practice Address - Country:US
Practice Address - Phone:478-452-6252
Practice Address - Fax:478-452-6255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
65BBBCQSMedicare ID - Type Unspecified