Provider Demographics
NPI:1467750471
Name:WOODWARD, BYBEE L (LMT)
Entity Type:Individual
Prefix:
First Name:BYBEE
Middle Name:L
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BYBEE
Other - Middle Name:L
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:2599 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7403
Mailing Address - Country:US
Mailing Address - Phone:575-644-0113
Mailing Address - Fax:
Practice Address - Street 1:2599 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7403
Practice Address - Country:US
Practice Address - Phone:575-644-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4738172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4738OtherWORKERS COMPENSATION