Provider Demographics
NPI:1912010976
Name:WOOD, ROBERT BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:WOOD
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 1:204 S IH 35
Mailing Address - Street 2:STE 203
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4126
Mailing Address - Country:US
Mailing Address - Phone:512-863-7761
Mailing Address - Fax:512-863-0973
Practice Address - Street 1:204 S IH 35
Practice Address - Street 2:STE 203
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4126
Practice Address - Country:US
Practice Address - Phone:512-863-7761
Practice Address - Fax:512-863-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5834587OtherAETNA
TX86414TOtherHMO BLUE
TX676548Medicare ID - Type Unspecified