Provider Demographics
NPI:1518219328
Name:WOOD, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 KETTERING BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3044 KETTERING BOULEVARD
Practice Address - Street 2:
Practice Address - City:MORAIN
Practice Address - State:OH
Practice Address - Zip Code:45439-1922
Practice Address - Country:US
Practice Address - Phone:614-227-6952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist