Provider Demographics
NPI:1376733535
Name:WOOD, LEONARD A (PT)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S MILTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6333
Mailing Address - Country:US
Mailing Address - Phone:928-226-0792
Mailing Address - Fax:928-779-6408
Practice Address - Street 1:1800 S MILTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6333
Practice Address - Country:US
Practice Address - Phone:928-226-0792
Practice Address - Fax:928-779-6408
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117087Medicare PIN