Provider Demographics
NPI:1376726547
Name:WOODS, SHANE M (COTA)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:M
Last Name:WOODS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:680 FLINN AVE UNIT 38
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2076
Mailing Address - Country:US
Mailing Address - Phone:805-523-2031
Mailing Address - Fax:888-511-2260
Practice Address - Street 1:680 FLINN AVE UNIT 38
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2076
Practice Address - Country:US
Practice Address - Phone:805-523-2031
Practice Address - Fax:888-511-2260
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOTA1226208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation