Provider Demographics
NPI:1710012430
Name:WOODS, SENECA J (DPT,MOT)
Entity Type:Individual
Prefix:
First Name:SENECA
Middle Name:J
Last Name:WOODS
Suffix:
Gender:M
Credentials:DPT,MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 W EMERALD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9015
Mailing Address - Country:US
Mailing Address - Phone:208-375-0666
Mailing Address - Fax:208-375-2996
Practice Address - Street 1:7550 W EMERALD ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9015
Practice Address - Country:US
Practice Address - Phone:208-375-0666
Practice Address - Fax:208-375-2996
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2182225100000X
IDPT-815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010160967OtherREGENCE BLUE SHIELD OF ID
IDTD581OtherBLUE CROSS OF IDAHO
ID1651513Medicare PIN