Provider Demographics
NPI:1558122069
Name:WOODALL, THURNETTA (LMT)
Entity Type:Individual
Prefix:
First Name:THURNETTA
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4986 TALBERT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5256
Mailing Address - Country:US
Mailing Address - Phone:614-716-9767
Mailing Address - Fax:
Practice Address - Street 1:1685 LANCE POINTE RD STE B
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4216
Practice Address - Country:US
Practice Address - Phone:419-891-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026688225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist