Provider Demographics
NPI:1740359132
Name:WORKMAN, WIDD W (DPT)
Entity type:Individual
Prefix:MR
First Name:WIDD
Middle Name:W
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S GILBERT RD
Mailing Address - Street 2:STE 115
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1602
Mailing Address - Country:US
Mailing Address - Phone:480-632-6667
Mailing Address - Fax:480-632-6668
Practice Address - Street 1:323 S GILBERT RD
Practice Address - Street 2:STE 115
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1602
Practice Address - Country:US
Practice Address - Phone:480-632-6667
Practice Address - Fax:480-632-6668
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7440208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation