Provider Demographics
NPI:1619549235
Name:WOODARD, PHILLIP PARNELL (LMT)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PARNELL
Last Name:WOODARD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 WILLOW RUN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1136
Mailing Address - Country:US
Mailing Address - Phone:210-392-1042
Mailing Address - Fax:
Practice Address - Street 1:16515 WILLOW RUN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1136
Practice Address - Country:US
Practice Address - Phone:210-392-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist