Provider Demographics
NPI:1598955098
Name:WOOD, FRED K (PT)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:K
Last Name:WOOD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-641-0002
Mailing Address - Fax:
Practice Address - Street 1:1015 KELLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5819
Practice Address - Country:US
Practice Address - Phone:731-641-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist