Provider Demographics
NPI:1760695720
Name:WOODS, TREVOR SHAWN (ATC)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:SHAWN
Last Name:WOODS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2328
Mailing Address - Country:US
Mailing Address - Phone:605-260-0988
Mailing Address - Fax:
Practice Address - Street 1:501 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3855
Practice Address - Country:US
Practice Address - Phone:605-668-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer