Provider Demographics
NPI:1740431741
Name:WOODRUFF, TONNA LEE (PTA)
Entity Type:Individual
Prefix:MR
First Name:TONNA
Middle Name:LEE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 208
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9664
Mailing Address - Country:US
Mailing Address - Phone:812-847-9675
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 208
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9664
Practice Address - Country:US
Practice Address - Phone:812-847-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003432A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant