Provider Demographics
NPI:1598958092
Name:WOODS, ROBERT BRADLEY (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRADLEY
Last Name:WOODS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W RAILROAD AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2154
Mailing Address - Country:US
Mailing Address - Phone:601-892-8707
Mailing Address - Fax:
Practice Address - Street 1:104 W RAILROAD AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2154
Practice Address - Country:US
Practice Address - Phone:601-892-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant