Provider Demographics
NPI:1851302103
Name:WOODWARD, GENA (PT)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:WOODWARD
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 1:8801 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2316
Mailing Address - Country:US
Mailing Address - Phone:501-223-3314
Mailing Address - Fax:501-223-8023
Practice Address - Street 1:8801 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2316
Practice Address - Country:US
Practice Address - Phone:501-223-3314
Practice Address - Fax:501-223-8023
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U747OtherBLUE CROSS BLUE SHIELD
AR5U747OtherHEALTH ADVANTAGE HMO
AR5U747B321Medicare PIN