Provider Demographics
NPI:1942445176
Name:WOOD, MICHAEL J (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:107 CONCORD PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1307
Practice Address - Country:US
Practice Address - Phone:314-842-2990
Practice Address - Fax:314-842-5162
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008034637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO151100007Medicare PIN
MO150900007Medicare PIN