Provider Demographics
NPI:1619901741
Name:WOODSIDE, ROBERT W (MPT DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:WOODSIDE
Suffix:
Gender:M
Credentials:MPT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HUNGERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1718
Mailing Address - Country:US
Mailing Address - Phone:240-740-5500
Mailing Address - Fax:
Practice Address - Street 1:MCPS PHYSICAL DISABILITIES PROGRAM
Practice Address - Street 2:8001 LYNNBROOK DRIVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4642
Practice Address - Country:US
Practice Address - Phone:240-740-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007781S25Medicare ID - Type Unspecified