Provider Demographics
NPI:1700208436
Name:WOOD, ANDREW (MS, ATC, LAT, CES)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 MARKRIDGE RD
Mailing Address - Street 2:8223
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4096
Mailing Address - Country:US
Mailing Address - Phone:919-519-7140
Mailing Address - Fax:919-515-8932
Practice Address - Street 1:4600 TRINITY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3924
Practice Address - Country:US
Practice Address - Phone:919-513-7140
Practice Address - Fax:919-515-8932
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist