Provider Demographics
NPI:1437671724
Name:WOOD, BEVERLY ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-7178
Mailing Address - Country:US
Mailing Address - Phone:843-430-0807
Mailing Address - Fax:
Practice Address - Street 1:2597 HWY 66
Practice Address - Street 2:
Practice Address - City:WHITMIRE
Practice Address - State:SC
Practice Address - Zip Code:29178
Practice Address - Country:US
Practice Address - Phone:803-694-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer