Provider Demographics
NPI:1861639387
Name:WOODS, KERRY (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:WOODS
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 1:4080 NELSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2439
Mailing Address - Country:US
Mailing Address - Phone:337-497-0434
Mailing Address - Fax:337-497-0469
Practice Address - Street 1:4080 NELSON RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2439
Practice Address - Country:US
Practice Address - Phone:337-497-0434
Practice Address - Fax:337-497-0469
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03301F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist