Provider Demographics
NPI:1659438877
Name:WOOD, CYNTHIA L (RPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:WOOD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD # 773
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5400
Mailing Address - Country:US
Mailing Address - Phone:310-913-8243
Mailing Address - Fax:310-828-6304
Practice Address - Street 1:1421 16TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2747
Practice Address - Country:US
Practice Address - Phone:310-913-8243
Practice Address - Fax:310-828-6304
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT17959AMedicare ID - Type Unspecified