Provider Demographics
NPI:1811385115
Name:WOODRUFF, ALLEN A (PT)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:A
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 QUAIL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2195
Mailing Address - Country:US
Mailing Address - Phone:817-914-2578
Mailing Address - Fax:
Practice Address - Street 1:6905 QUAIL MEADOW DR
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2195
Practice Address - Country:US
Practice Address - Phone:817-914-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1244721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist