Provider Demographics
NPI:1487227633
Name:WOODARD, CARLA ANNETTE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANNETTE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ANNETTE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2382 ROZELLE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-5701
Mailing Address - Country:US
Mailing Address - Phone:313-530-8130
Mailing Address - Fax:
Practice Address - Street 1:3385 AIRWAYS BLVD STE 123
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3830
Practice Address - Country:US
Practice Address - Phone:901-425-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist