Provider Demographics
NPI:1831477660
Name:WOODARD, MELODY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:ANN
Last Name:WOODARD
Suffix:
Gender:F
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-0250
Mailing Address - Country:US
Mailing Address - Phone:404-309-5200
Mailing Address - Fax:404-591-8002
Practice Address - Street 1:2869 AMESBURY PL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7382
Practice Address - Country:US
Practice Address - Phone:404-309-5200
Practice Address - Fax:404-591-8002
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist