Provider Demographics
NPI:1598019218
Name:WOOD, DALLAS (MED,,ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DALLAS
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MED,,ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 STOKES CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4430
Mailing Address - Country:US
Mailing Address - Phone:757-642-1025
Mailing Address - Fax:
Practice Address - Street 1:1604 STOKES CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4430
Practice Address - Country:US
Practice Address - Phone:757-642-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260002662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer