Provider Demographics
NPI:1609833847
Name:WOOD, DANIEL W (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 BAYOU ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-9232
Mailing Address - Country:US
Mailing Address - Phone:318-283-2080
Mailing Address - Fax:318-283-0606
Practice Address - Street 1:3867 BAYOU ACRES DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-9232
Practice Address - Country:US
Practice Address - Phone:318-283-2080
Practice Address - Fax:318-283-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00809R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0196531OtherDEPARTMENT OF LABOR
LACH5484OtherRAILROAD MEDICARE
LA1437158Medicaid
LACH5484OtherRAILROAD MEDICARE